Ultrasonic surgical instrument with dual modes

ABSTRACT

A surgical apparatus comprises a body, a shaft assembly, and an end effector. The end effector comprises a clamp arm and an ultrasonic blade in acoustic communication with an ultrasonic transducer via an acoustic waveguide that extends through the shaft assembly. The clamp arm is configured to pivot about a first pivot point toward and away from the ultrasonic blade along a first angular path from a first position to a second position to thereby provide a tissue sealing mode of operation. The clamp arm is further configured to pivot about a second pivot point toward and away from the ultrasonic blade along second angular path from the second position to a third position to thereby provide a tissue cutting and sealing mode of operation. The second pivot point is proximal to the first pivot point.

PRIORITY

This Application claims priority to U.S. Patent App. No. 62/094,244,entitled “Ultrasonic Surgical Instrument with Dual Modes,” filed Dec.19, 2014, the disclosure of which is incorporated by reference herein.

BACKGROUND

A variety of surgical instruments include an end effector having a bladeelement that vibrates at ultrasonic frequencies to cut and/or sealtissue (e.g., by denaturing proteins in tissue cells). These instrumentsinclude one or more piezoelectric elements that convert electrical powerinto ultrasonic vibrations, which are communicated along an acousticwaveguide to the blade element. The precision of cutting and coagulationmay be controlled by the operator's technique and adjusting the powerlevel, blade edge angle, tissue traction, and blade pressure.

Examples of ultrasonic surgical instruments include the HARMONIC ACE®Ultrasonic Shears, the HARMONIC WAVE® Ultrasonic Shears, the HARMONICFOCUS® Ultrasonic Shears, and the HARMONIC SYNERGY® Ultrasonic Blades,all by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Further examplesof such devices and related concepts are disclosed in U.S. Pat. No.5,322,055, entitled “Clamp Coagulator/Cutting System for UltrasonicSurgical Instruments,” issued Jun. 21, 1994, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 5,873,873, entitled“Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp Mechanism,”issued Feb. 23, 1999, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 5,980,510, entitled “Ultrasonic ClampCoagulator Apparatus Having Improved Clamp Arm Pivot Mount,” issued Nov.9, 1999, the disclosure of which is incorporated by reference herein;U.S. Pat. No. 6,283,981, entitled “Method of Balancing AsymmetricUltrasonic Surgical Blades,” issued Sep. 4, 2001, the disclosure ofwhich is incorporated by reference herein; U.S. Pat. No. 6,309,400,entitled “Curved Ultrasonic Blade having a Trapezoidal Cross Section,”issued Oct. 30, 2001, the disclosure of which is incorporated byreference herein; U.S. Pat. No. 6,325,811, entitled “Blades withFunctional Balance Asymmetries for use with Ultrasonic SurgicalInstruments,” issued Dec. 4, 2001, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 6,423,082, entitled“Ultrasonic Surgical Blade with Improved Cutting and CoagulationFeatures,” issued Jul. 23, 2002, the disclosure of which is incorporatedby reference herein; U.S. Pat. No. 6,773,444, entitled “Blades withFunctional Balance Asymmetries for Use with Ultrasonic SurgicalInstruments,” issued Aug. 10, 2004, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 6,783,524, entitled“Robotic Surgical Tool with Ultrasound Cauterizing and CuttingInstrument,” issued Aug. 31, 2004, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,057,498, entitled“Ultrasonic Surgical Instrument Blades,” issued Nov. 15, 2011, thedisclosure of which is incorporated by reference herein; U.S. Pat. No.8,461,744, entitled “Rotating Transducer Mount for Ultrasonic SurgicalInstruments,” issued Jun. 11, 2013, the disclosure of which isincorporated by reference herein; U.S. Pat. No. 8,591,536, entitled“Ultrasonic Surgical Instrument Blades,” issued Nov. 26, 2013, thedisclosure of which is incorporated by reference herein; and U.S. Pat.No. 8,623,027, entitled “Ergonomic Surgical Instruments,” issued Jan. 7,2014, the disclosure of which is incorporated by reference herein.

Still further examples of ultrasonic surgical instruments are disclosedin U.S. Pub. No. 2006/0079874, entitled “Tissue Pad for Use with anUltrasonic Surgical Instrument,” published Apr. 13, 2006, the disclosureof which is incorporated by reference herein; U.S. Pub. No.2007/0191713, entitled “Ultrasonic Device for Cutting and Coagulating,”published Aug. 16, 2007, the disclosure of which is incorporated byreference herein; U.S. Pub. No. 2007/0282333, entitled “UltrasonicWaveguide and Blade,” published Dec. 6, 2007, the disclosure of which isincorporated by reference herein; U.S. Pub. No. 2008/0200940, entitled“Ultrasonic Device for Cutting and Coagulating,” published Aug. 21,2008, the disclosure of which is incorporated by reference herein; U.S.Pub. No. 2008/0234710, entitled “Ultrasonic Surgical Instruments,”published Sep. 25, 2008, the disclosure of which is incorporated byreference herein; and U.S. Pub. No. 2010/0069940, entitled “UltrasonicDevice for Fingertip Control,” published Mar. 18, 2010, the disclosureof which is incorporated by reference herein.

Some ultrasonic surgical instruments may include a cordless transducersuch as that disclosed in U.S. Pub. No. 2012/0112687, entitled “RechargeSystem for Medical Devices,” published May 10, 2012, the disclosure ofwhich is incorporated by reference herein; U.S. Pub. No. 2012/0116265,entitled “Surgical Instrument with Charging Devices,” published May 10,2012, the disclosure of which is incorporated by reference herein;and/or U.S. Pat. App. No. 61/410,603, filed Nov. 5, 2010, entitled“Energy-Based Surgical Instruments,” the disclosure of which isincorporated by reference herein.

Additionally, some ultrasonic surgical instruments may include anarticulating shaft section. Examples of such ultrasonic surgicalinstruments are disclosed in U.S. Pub. No. 2014/0005701, published Jan.2, 2014, entitled “Surgical Instruments with Articulating Shafts,” thedisclosure of which is incorporated by reference herein; and U.S. Pub.No. 2014/0114334, published Apr. 24, 2014, entitled “Flexible HarmonicWaveguides/Blades for Surgical Instruments,” the disclosure of which isincorporated by reference herein.

While several surgical instruments and systems have been made and used,it is believed that no one prior to the inventors has made or used theinvention described in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim this technology, it is believed this technologywill be better understood from the following description of certainexamples taken in conjunction with the accompanying drawings, in whichlike reference numerals identify the same elements and in which:

FIG. 1 depicts a block schematic view of an exemplary surgical system;

FIG. 2 depicts a side elevational view of an exemplary surgicalinstrument operable for use with the system of FIG. 1;

FIG. 3 depicts a cross-sectional side view of an end effector of theinstrument of FIG. 2 in a closed position;

FIG. 4 depicts a cross-sectional side view of the end effector of FIG. 3in an open position;

FIG. 5 depicts a cross-sectional side view of a handle assembly of theinstrument of FIG. 2;

FIG. 6 depicts a perspective view of an exemplary alternative ultrasonicsurgical instrument operable for use with the system of FIG. 1;

FIG. 7 depicts a side elevational view of the instrument of FIG. 6;

FIG. 8 depicts a perspective view of a shaft assembly and end effectorof the instrument of FIG. 6;

FIG. 9 depicts a side elevational view of the end effector of FIG. 8;

FIG. 10 depicts an exploded perspective view of the shaft assembly andend effector of FIG. 8;

FIG. 11 depicts a perspective view of a pivot arm of the shaft assemblyand end effector of FIG. 8;

FIG. 12 depicts a side elevational view of the pivot arm of FIG. 11;

FIG. 13 depicts a perspective view of a pivot tube of the shaft assemblyof FIG. 8;

FIG. 14 depicts a perspective view of a distal portion of an outersheath of the shaft assembly of FIG. 8;

FIG. 15 depicts a perspective view of a distal portion of an inner tubeof the shaft assembly of FIG. 8;

FIG. 16 depicts a side elevational view of a handle assembly of theinstrument of FIG. 6 with a housing shroud removed;

FIG. 17A depicts a side elevational view of the shaft assembly and endeffector of FIG. 8 with the pivot tube of FIG. 13 in a firstlongitudinal position, with the pivot arm of FIG. 11 in a firstrotational position, with the inner tube of FIG. 15 in a firstlongitudinal position, and with a clamp arm of the end effector in afirst vertical position and a first rotational position;

FIG. 17B depicts a side elevational view of the shaft assembly and endeffector of FIG. 8 with the pivot tube of FIG. 13 moved to a secondlongitudinal position, and with the clamp arm of FIG. 17A moved to asecond rotational position by movement of the inner tube of FIG. 15 to asecond longitudinal position;

FIG. 17C depicts a side elevational view of the shaft assembly and endeffector of FIG. 8 with the clamp arm of FIG. 17A moved to a secondvertical position by movement of the pivot arm of FIG. 11 to a secondrotational position by movement of the pivot tube of FIG. 13 to a thirdlongitudinal position;

FIG. 18A depicts a side elevational view of the end effector of FIG. 8with the pivot arm of FIG. 11 in the first rotational position, with theinner tube of FIG. 15 in the first longitudinal position, and with theclamp arm of FIG. 17A in the first vertical position and the firstrotational position;

FIG. 18B depicts a side elevational view of the end effector of FIG. 8with the clamp arm of FIG. 17A moved to the second rotational positionby movement of the inner tube of FIG. 15 to the second longitudinalposition;

FIG. 18C depicts a side elevational view of the end effector of FIG. 8with the clamp arm of FIG. 17A moved to the second vertical position bymovement of the pivot arm of FIG. 11 to the second rotational position;

FIG. 19A depicts a side perspective view of the handle assembly of FIG.16 with a housing shroud removed, with a trigger of the handle assemblyin a first rotational position, with the inner tube of FIG. 15 in thefirst longitudinal position, and with the clamp arm of FIG. 17A in thefirst vertical position and the first rotational position;

FIG. 19B depicts a side perspective view of the handle assembly of FIG.16 with a housing shroud removed, with the pivot tube of FIG. 13 and theinner tube of FIG. 15 moved to the second longitudinal positions byrotation of the trigger of FIG. 19A to a second rotational position;

FIG. 19C depicts a side perspective view of the handle assembly of FIG.16 with a housing shroud removed with the pivot tube of FIG. 13 moved tothe third longitudinal position by rotation of the trigger of FIG. 19Ato a third rotational position;

FIG. 20 depicts a detailed side elevational view of an exemplaryalternative shaft assembly and end effector operable for use with theinstrument of FIG. 6;

FIG. 21 depicts a detailed side elevational view of another exemplaryalternative shaft assembly and end effector operable for use with theinstrument of FIG. 6;

FIG. 22 depicts a detailed side elevational view of yet anotherexemplary alternative shaft assembly and end effector operable for usewith the instrument of FIG. 6;

FIG. 23A depicts a detailed side elevational view of the shaft assemblyand end effector of FIG. 22, with a portion of a pivot arm omitted toshow a sled, with the sled of the shaft assembly in a first longitudinalposition, and with a clamp arm of the end effector in a first verticalposition;

FIG. 23B depicts a detailed side elevational view of the shaft assemblyand end effector of FIG. 22, with a portion of a pivot arm omitted toshow a sled, with the clamp arm of FIG. 23A moved to a second verticalposition by movement of the sled of FIG. 23A to a second longitudinalposition;

FIG. 24A depicts a side elevational view of yet another exemplary shaftassembly and end effector operable for use with the instrument of FIG. 6with a pivot tube of the shaft assembly in a first longitudinalposition, with a four-bar linkage in a first position, with an innertube of the shaft assembly in a first longitudinal position, and with aclamp arm of the end effector in a first vertical position and a firstrotational position;

FIG. 24B depicts a side elevational view of the shaft assembly and endeffector of FIG. 24A with the clamp arm of FIG. 24A moved to a secondrotational position by movement of the inner tube of FIG. 24A to asecond longitudinal position;

FIG. 24C depicts a side elevational view of the shaft assembly and endeffector of FIG. 24A with the clamp arm of FIG. 24A moved to a secondvertical position by movement of four-bar linkage to a second positionby movement of the pivot tube of FIG. 24A to a second longitudinalposition;

FIG. 25 depicts a side elevational view of an exemplary alternativehandle assembly operable for use with the instrument of FIG. 6;

FIG. 26A depicts a side elevational view of the handle assembly of FIG.25 with a housing shroud removed and having an exemplary switchassembly, with a switch of the switch assembly in a distal position, andwith an inner tube of the handle assembly in a first longitudinalposition;

FIG. 26B depicts a side elevational view of the handle assembly of FIG.25 with a housing shroud removed and having the switch assembly of FIG.26A, with the switch of FIG. 26A in the distal position, and with theinner tube of FIG. 26A moved into a second longitudinal position intocontact with the switch;

FIG. 26C depicts a side elevational view of the handle assembly of FIG.25 with a housing shroud removed and having the switch assembly of FIG.26A, with the switch of FIG. 26A moved into a proximal position, andwith the inner tube of FIG. 26A in the second longitudinal position;

FIG. 26D depicts a side elevational view of the handle assembly of FIG.25 with a housing shroud removed and having the switch assembly of FIG.26A, with the switch of FIG. 26A in the proximal position, and with theinner tube of FIG. 26A moved into a third longitudinal position intocontact with the switch;

FIG. 27A depicts a side elevational view of an exemplary alternative endeffector and an exemplary alternative shaft assembly that may beincorporated into the instrument of FIG. 2, with the end effector in anopen position;

FIG. 27B depicts a side elevational view of the end effector and shaftassembly of FIG. 27A, with the end effector in a first closed position;

FIG. 27C depicts a side elevational view of the end effector and theshaft assembly of FIG. 27A, with the end effector in a second closedposition;

FIG. 28A depicts a cross-sectional front view of the end effector ofFIG. 27A taken along line 28A-28A of FIG. 27B;

FIG. 28B depicts a cross-sectional front view of the end effector ofFIG. 27A taken along line 28B-28B of FIG. 27C;

FIG. 29A depicts a cross-sectional side view of another exemplaryalternative end effector and another exemplary alternative shaftassembly that may be incorporated in the instrument of FIG. 2, with theend effector in an open position;

FIG. 29B depicts a cross-sectional side view of the end effector and theshaft assembly of FIG. 29A, with the end effector in a first closedposition;

FIG. 29C depicts a cross-sectional side view of the end effector and theshaft assembly of FIG. 29A, with the end effector in a second closedposition;

FIG. 30A depicts a cross-sectional side view of another exemplaryalternative end effector and another exemplary alternative shaftassembly that may be incorporated into the instrument of FIG. 2, withthe end effector in an open position;

FIG. 30B depicts a cross-sectional side view of the end effector andshaft assembly of FIG. 30A, with the end effector in a first closedposition;

FIG. 30C depicts a cross-sectional side view of the end effector andshaft assembly of FIG. 30A, with the end effector in a second closedposition;

FIG. 31A depicts a cross-sectional front view of the end effector andshaft assembly of FIG. 30A taken along line 31A-31A of FIG. 30B;

FIG. 31B depicts a cross-sectional front view of the end effector andshaft assembly of FIG. 30A taken along line 31B-31B of FIG. 30C;

FIG. 32A depicts a cross-sectional side view of another exemplaryalternative end effector and another exemplary alternative shaftassembly that may be incorporated into the surgical instrument of FIG.2;

FIG. 32B depicts a cross-sectional side view of the end effector andshaft assembly of FIG. 32A, with the end effector in a first closedposition;

FIG. 32C depicts a cross-sectional side view of the end effector andshaft assembly of FIG. 32A, with the end effector in a second closedposition;

FIG. 33 depicts a cross-sectional front view of the shaft assembly ofFIG. 32A taken along line 33-33 of FIG. 32B; and

FIG. 34 depicts a cross-sectional front view of the shaft assembly ofFIG. 32A taken along line 34-34 of FIG. 32C.

The drawings are not intended to be limiting in any way, and it iscontemplated that various embodiments of the technology may be carriedout in a variety of other ways, including those not necessarily depictedin the drawings. The accompanying drawings incorporated in and forming apart of the specification illustrate several aspects of the presenttechnology, and together with the description serve to explain theprinciples of the technology; it being understood, however, that thistechnology is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

It is further understood that any one or more of the teachings,expressions, embodiments, examples, etc. described herein may becombined with any one or more of the other teachings, expressions,embodiments, examples, etc. that are described herein. Thefollowing-described teachings, expressions, embodiments, examples, etc.should therefore not be viewed in isolation relative to each other.Various suitable ways in which the teachings herein may be combined willbe readily apparent to those of ordinary skill in the art in view of theteachings herein. Such modifications and variations are intended to beincluded within the scope of the claims.

For clarity of disclosure, the terms “proximal” and “distal” are definedherein relative to an operator or other operator grasping a surgicalinstrument having a distal surgical end effector. The term “proximal”refers the position of an element closer to the operator or otheroperator and the term “distal” refers to the position of an elementcloser to the surgical end effector of the surgical instrument andfurther away from the operator or other operator.

I. OVERVIEW OF EXEMPLARY ULTRASONIC SURGICAL SYSTEM

FIG. 1 shows components of an exemplary surgical system (10) indiagrammatic block form. As shown, system (10) comprises an ultrasonicgenerator (12) and an ultrasonic surgical instrument (20). As will bedescribed in greater detail below, instrument (20) is operable to cuttissue and seal or weld tissue (e.g., a blood vessel, etc.)substantially simultaneously, using ultrasonic vibrational energy.Generator (12) and instrument (20) are coupled together via cable (14).Cable (14) may comprise a plurality of wires; and may provideunidirectional electrical communication from generator (12) toinstrument (20) and/or bidirectional electrical communication betweengenerator (12) and instrument (20). By way of example only, cable (14)may comprise a “hot” wire for electrical power to surgical instrument(20), a ground wire, and a signal wire for transmitting signals fromsurgical instrument (20) to ultrasonic generator (12), with a shieldsurrounding the three wires. In some versions, separate “hot” wires areused for separate activation voltages (e.g., one “hot” wire for a firstactivation voltage and another “hot” wire for a second activationvoltage, or a variable voltage between the wires proportional to thepower requested, etc.). Of course, any other suitable number orconfiguration of wires may be used. It should also be understood thatsome versions of system (10) may incorporate generator (12) intoinstrument (20), such that cable (14) may simply be omitted.

By way of example only, generator (12) may comprise the GEN04, GEN11, orGEN 300 sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio. Inaddition or in the alternative, generator (12) may be constructed inaccordance with at least some of the teachings of U.S. Pub. No.2011/0087212, entitled “Surgical Generator for Ultrasonic andElectrosurgical Devices,” published Apr. 14, 2011, the disclosure ofwhich is incorporated by reference herein. Alternatively, any othersuitable generator (12) may be used. As will be described in greaterdetail below, generator (12) is operable to provide power to instrument(20) to perform ultrasonic surgical procedures.

Instrument (20) comprises a handle assembly (22), which is configured tobe grasped in one hand (or two hands) of an operator and manipulated byone hand (or two hands) of the operator during a surgical procedure. Forinstance, in some versions, handle assembly (22) may be grasped like apencil by the operator. In some other versions, handle assembly (22) mayinclude a scissor grip that may be grasped like scissors by theoperator. In some other versions, handle assembly (22) may include apistol grip that may be grasped like a pistol by the operator. Ofcourse, handle assembly (22) may be configured to be gripped in anyother suitable fashion. Furthermore, some versions of instrument (20)may substitute handle assembly (22) with a body that is coupled to arobotic surgical system that is configured to operate instrument (20)(e.g., via remote control, etc.). In the present example, a blade (24)extends distally from the handle assembly (22). Handle assembly (22)includes an ultrasonic transducer (26) and an ultrasonic waveguide (28),which couples ultrasonic transducer (26) with blade (24). Ultrasonictransducer (26) receives electrical power from generator (12) via cable(14). By virtue of its piezoelectric properties, ultrasonic transducer(26) is operable to convert such electrical power into ultrasonicvibrational energy.

Ultrasonic waveguide (28) may be flexible, semi-flexible, rigid, or haveany other suitable properties. As noted above, ultrasonic transducer(26) is integrally coupled with blade (24) via ultrasonic waveguide(28). In particular, when ultrasonic transducer (26) is activated tovibrate at ultrasonic frequencies, such vibrations are communicatedthrough ultrasonic waveguide (28) to blade (24), such that blade (24)will also vibrate at ultrasonic frequencies. When blade (24) is in anactivated state (i.e., vibrating ultrasonically), blade (24) is operableto effectively cut through tissue and seal tissue. Ultrasonic transducer(26), ultrasonic waveguide (28), and blade (24) together thus form anacoustic assembly providing ultrasonic energy for surgical procedureswhen powered by generator (12). Handle assembly (22) is configured tosubstantially isolate the operator from the vibrations of the acousticassembly formed by transducer (26), ultrasonic waveguide (28), and blade(24).

In some versions, ultrasonic waveguide (28) may amplify the mechanicalvibrations transmitted through ultrasonic waveguide (28) to blade (24).Ultrasonic waveguide (28) may further have features to control the gainof the longitudinal vibration along ultrasonic waveguide (28) and/orfeatures to tune ultrasonic waveguide (28) to the resonant frequency ofsystem (10). For instance, ultrasonic waveguide (28) may have anysuitable cross-sectional dimensions/configurations, such as asubstantially uniform cross-section, be tapered at various sections, betapered along its entire length, or have any other suitableconfiguration. Ultrasonic waveguide (28) may, for example, have a lengthsubstantially equal to an integral number of one-half system wavelengths(nλ/2). Ultrasonic waveguide (28) and blade (24) may be fabricated froma solid core shaft constructed out of a material or combination ofmaterials that propagates ultrasonic energy efficiently, such astitanium alloy (i.e., Ti-6A1-4V), aluminum alloys, sapphire, stainlesssteel, or any other acoustically compatible material or combination ofmaterials.

In the present example, the distal end of blade (24) is located at aposition corresponding to an anti-node associated with resonantultrasonic vibrations communicated through waveguide (28) (i.e., at anacoustic anti-node), in order to tune the acoustic assembly to apreferred resonant frequency f_(o) when the acoustic assembly is notloaded by tissue. When transducer (26) is energized, the distal end ofblade (24) is configured to move longitudinally in the range of, forexample, approximately 10 to 500 microns peak-to-peak, and in someinstances in the range of about 20 to about 200 microns at apredetermined vibratory frequency f_(o) of, for example, 55.5 kHz. Whentransducer (26) of the present example is activated, these mechanicaloscillations are transmitted through waveguide (28) to reach blade (24),thereby providing oscillation of blade (24) at the resonant ultrasonicfrequency. Thus, the ultrasonic oscillation of blade (24) maysimultaneously sever the tissue and denature the proteins in adjacenttissue cells, thereby providing a coagulative effect with relativelylittle thermal spread. In some versions, an electrical current may alsobe provided through blade (24) to also cauterize the tissue.

By way of example only, ultrasonic waveguide (28) and blade (24) maycomprise components sold under product codes SNGHK and SNGCB by EthiconEndo-Surgery, Inc. of Cincinnati, Ohio. By way of further example only,ultrasonic waveguide (28) and/or blade (24) may be constructed andoperable in accordance with the teachings of U.S. Pat. No. 6,423,082,entitled “Ultrasonic Surgical Blade with Improved Cutting andCoagulation Features,” issued Jul. 23, 2002, the disclosure of which isincorporated by reference herein. As another merely illustrativeexample, ultrasonic waveguide (28) and/or blade (24) may be constructedand operable in accordance with the teachings of U.S. Pat. No.5,324,299, entitled “Ultrasonic Scalpel Blade and Methods ofApplication,” issued Jun. 28, 1994, the disclosure of which isincorporated by reference herein. Other suitable properties andconfigurations of ultrasonic waveguide (28) and blade (24) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

Handle assembly (22) of the present example also includes a controlselector (30) and an activation switch (32), which are each incommunication with a circuit board (34). By way of example only, circuitboard (34) may comprise a conventional printed circuit board, a flexcircuit, a rigid-flex circuit, or may have any other suitableconfiguration. Control selector (30) and activation switch (32) may bein communication with circuit board (34) via one or more wires, tracesformed in a circuit board or flex circuit, and/or in any other suitablefashion. Circuit board (34) is coupled with cable (14), which is in turncoupled with control circuitry (16) within generator (12). Activationswitch (32) is operable to selectively activate power to ultrasonictransducer (26). In particular, when switch (32) is activated, suchactivation provides communication of appropriate power to ultrasonictransducer (26) via cable (14). By way of example only, activationswitch (32) may be constructed in accordance with any of the teachingsof the various references cited herein. Other various forms thatactivation switch (32) may take will be apparent to those of ordinaryskill in the art in view of the teachings herein.

In the present example, surgical system (10) is operable to provide atleast two different levels or types of ultrasonic energy (e.g.,different frequencies and/or amplitudes, etc.) at blade (24). To thatend, control selector (30) is operable to permit the operator to selecta desired level/amplitude of ultrasonic energy. By way of example only,control selector (30) may be constructed in accordance with any of theteachings of the various references cited herein. Other various formsthat control selector (30) may take will be apparent to those ofordinary skill in the art in view of the teachings herein. In someversions, when an operator makes a selection through control selector(30), the operator's selection is communicated back to control circuitry(16) of generator (12) via cable (14), and control circuitry (16)adjusts the power communicated from generator (12) accordingly the nexttime the operator actuates activation switch (32).

It should be understood that the level/amplitude of ultrasonic energyprovided at blade (24) may be a function of characteristics of theelectrical power communicated from generator (12) to instrument (20) viacable (14). Thus, control circuitry (16) of generator (12) may provideelectrical power (via cable (14)) having characteristics associated withthe ultrasonic energy level/amplitude or type selected through controlselector (30). Generator (12) may thus be operable to communicatedifferent types or degrees of electrical power to ultrasonic transducer(26), in accordance with selections made by the operator via controlselector (30). In particular, and by way of example only, generator (12)may increase the voltage and/or current of the applied signal toincrease the longitudinal amplitude of the acoustic assembly. As amerely illustrative example, generator (12) may provide selectabilitybetween a “level 1” and a “level 5,” which may correspond with a blade(24) vibrational resonance amplitude of approximately 50 microns andapproximately 90 microns, respectively. Various ways in which controlcircuitry (16) may be configured will be apparent to those of ordinaryskill in the art in view of the teachings herein. It should also beunderstood that control selector (30) and activation switch (32) may besubstituted with two or more activation switches (32). In some suchversions, one activation switch (32) is operable to activate blade (24)at one power level/type while another activation switch (32) is operableto activate blade (24) at another power level/type, etc.

In some alternative versions, control circuitry (16) is located withinhandle assembly (22). For instance, in some such versions, generator(12) only communicates one type of electrical power (e.g., just onevoltage and/or current available) to handle assembly (22), and controlcircuitry (16) within handle assembly (22) is operable to modify theelectrical power (e.g., the voltage of the electrical power), inaccordance with selections made by the operator via control selector(30), before the electrical power reaches ultrasonic transducer (26).Furthermore, generator (12) may be incorporated into handle assembly(22) along with all other components of surgical system (10). Forinstance, one or more batteries (not shown) or other portable sources ofpower may be provided in handle assembly (22). Still other suitable waysin which the components depicted in FIG. 1 may be rearranged orotherwise configured or modified will be apparent to those of ordinaryskill in the art in view of the teachings herein.

II. OVERVIEW OF EXEMPLARY ULTRASONIC SURGICAL INSTRUMENT

The following discussion relates to various exemplary components andconfigurations of instrument (20). It should be understood that thevarious examples of instrument (20) described below may be readilyincorporated into surgical system (10) as described above. It shouldalso be understood that the various components and operabilities ofinstrument (20) described above may be readily incorporated into theexemplary versions of instrument (20) described below. Various suitableways in which the above and below teachings may be combined will beapparent to those of ordinary skill in the art in view of the teachingsherein. It should also be understood that the below teachings may bereadily combined with the various teachings of the references that arecited herein.

FIGS. 2-5 illustrate an exemplary ultrasonic surgical instrument (100).At least part of instrument (100) may be constructed and operable inaccordance with at least some of the teachings of U.S. Pat. Nos.5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,773,444; 6,783,524;8,461,744; 8,623,027; U.S. Pub. No. 2006/0079874; U.S. Pub. No.2007/0191713; U.S. Pub. No. 2007/0282333; U.S. Pub. No. 2008/0200940;U.S. Pub. No. 2010/0069940; U.S. Pub. No. 2012/0112687; U.S. Pub. No.2012/0116265; U.S. Pub. No. 2014/0005701; U.S. Pub. No. 2014/0114334;U.S. Pat. App. No. 61/410,603; and/or U.S. patent application Ser. No.14/028,717. The disclosures of each of the foregoing patents,publications, and applications are incorporated by reference herein. Asdescribed therein and as will be described in greater detail below,instrument (100) is operable to cut tissue and seal or weld tissue(e.g., a blood vessel, etc.) substantially simultaneously. It shouldalso be understood that instrument (100) may have various structural andfunctional similarities with the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and/or the HARMONIC SYNERGY® Ultrasonic Blades. Furthermore, instrument(100) may have various structural and functional similarities with thedevices taught in any of the other references that are cited andincorporated by reference herein.

To the extent that there is some degree of overlap between the teachingsof the references cited herein, the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and/or the HARMONIC SYNERGY® Ultrasonic Blades, and the followingteachings relating to instrument (100), there is no intent for any ofthe description herein to be presumed as admitted prior art. Severalteachings herein will in fact go beyond the scope of the teachings ofthe references cited herein and the HARMONIC ACE® Ultrasonic Shears, theHARMONIC WAVE® Ultrasonic Shears, the HARMONIC FOCUS® Ultrasonic Shears,and the HARMONIC SYNERGY® Ultrasonic Blades.

Instrument (100) of the present example comprises a handle assembly(120), a shaft assembly (130), and an end effector (140). Handleassembly (120) comprises a body (122) including a pistol grip (124) anda pair of buttons (126). Handle assembly (120) also includes a trigger(128) that is pivotable toward and away from pistol grip (124). Itshould be understood, however, that various other suitableconfigurations may be used, including but not limited to a pencil-gripconfiguration or a scissor-grip configuration. End effector (140)includes an ultrasonic blade (160) and a pivoting clamp arm (144). Clamparm (144) is coupled with trigger (128) such that clamp arm (144) ispivotable toward ultrasonic blade (160) in response to pivoting oftrigger (128) toward pistol grip (124); and such that clamp arm (144) ispivotable away from ultrasonic blade (160) in response to pivoting oftrigger (128) away from pistol grip (124). Various suitable ways inwhich clamp arm (144) may be coupled with trigger (128) will be apparentto those of ordinary skill in the art in view of the teachings herein.In some versions, one or more resilient members are used to bias clamparm (144) and/or trigger (128) to the open position shown in FIG. 4.

An ultrasonic transducer assembly (112) extends proximally from body(122) of handle assembly (120). Transducer assembly (112) is coupledwith a generator (116) via a cable (114). Transducer assembly (112)receives electrical power from generator (116) and converts that powerinto ultrasonic vibrations through piezoelectric principles. Generator(116) may include a power source and control module that is configuredto provide a power profile to transducer assembly (112) that isparticularly suited for the generation of ultrasonic vibrations throughtransducer assembly (112). By way of example only, generator (116) maycomprise a GEN 300 sold by Ethicon Endo-Surgery, Inc. of Cincinnati,Ohio. In addition or in the alternative, generator (116) may beconstructed in accordance with at least some of the teachings of U.S.Pub. No. 2011/0087212, entitled “Surgical Generator for Ultrasonic andElectrosurgical Devices,” published Apr. 14, 2011, the disclosure ofwhich is incorporated by reference herein. It should also be understoodthat at least some of the functionality of generator (116) may beintegrated into handle assembly (120), and that handle assembly (120)may even include a battery or other on-board power source such thatcable (114) is omitted. Still other suitable forms that generator (116)may take, as well as various features and operabilities that generator(116) may provide, will be apparent to those of ordinary skill in theart in view of the teachings herein.

Blade (160) of the present example is operable to vibrate at ultrasonicfrequencies in order to effectively cut through and seal tissue,particularly when the tissue is being clamped between clamp arm (144)and blade (160). Blade (160) is positioned at the distal end of anacoustic drivetrain. This acoustic drivetrain includes transducerassembly (112) and an acoustic waveguide (102). Transducer assembly(112) includes a set of piezoelectric discs (not shown) located proximalto a horn (not shown) of rigid acoustic waveguide (102). Thepiezoelectric discs are operable to convert electrical power intoultrasonic vibrations, which are then transmitted along acousticwaveguide (102), which extends through shaft assembly (130), to blade(160) in accordance with known configurations and techniques. By way ofexample only, this portion of the acoustic drivetrain may be configuredin accordance with various teachings of various references that arecited herein.

Waveguide (102) is secured within shaft assembly (130) via a pin (133),which passes through waveguide (102) and shaft assembly (130). Pin (133)is located at a position along the length of waveguide (102)corresponding to a node associated with resonant ultrasonic vibrationscommunicated through waveguide (102). When ultrasonic blade (160) is inan activated state (i.e., vibrating ultrasonically), ultrasonic blade(160) is operable to effectively cut through and seal tissue,particularly when the tissue is being clamped between clamp arm (144)and ultrasonic blade (160). It should be understood that waveguide (102)may be configured to amplify mechanical vibrations transmitted throughwaveguide (102). Furthermore, waveguide (102) may include featuresoperable to control the gain of the longitudinal vibrations alongwaveguide (102) and/or features to tune waveguide (102) to the resonantfrequency of the system.

In the present example, the distal end of blade (160) is located at aposition corresponding to an anti-node associated with resonantultrasonic vibrations communicated through waveguide (102), in order totune the acoustic assembly to a preferred resonant frequency f_(o) whenthe acoustic assembly is not loaded by tissue. When transducer assembly(112) is energized, the distal end of blade (160) is configured to movelongitudinally in the range of, for example, approximately 10 to 500microns peak-to-peak, and in some instances in the range of about 20 toabout 200 microns at a predetermined vibratory frequency f_(o) of, forexample, 55.5 kHz. When transducer assembly (112) of the present exampleis activated, these mechanical oscillations are transmitted throughwaveguide (102) to reach blade (160), thereby providing oscillation ofblade (160) at the resonant ultrasonic frequency. Thus, when tissue issecured between blade (160) and clamp arm (144), the ultrasonicoscillation of blade (160) may simultaneously sever the tissue anddenature the proteins in adjacent tissue cells, thereby providing acoagulative effect with relatively little thermal spread. In someversions, an electrical current may also be provided through blade (160)and clamp arm (144) to also cauterize the tissue. While someconfigurations for an acoustic transmission assembly and transducerassembly (112) have been described, still other suitable configurationsfor an acoustic transmission assembly and transducer assembly (112) willbe apparent to one or ordinary skill in the art in view of the teachingsherein. Similarly, other suitable configurations for end effector (140)will be apparent to those of ordinary skill in the art in view of theteachings herein.

An operator may activate buttons (126) to selectively activatetransducer assembly (112) to activate blade (160). In the presentexample, two buttons (126) are provided—one for activating blade (160)at a low power and another for activating blade (160) at a high power.However, it should be understood that any other suitable number ofbuttons and/or otherwise selectable power levels may be provided. Forinstance, a foot pedal may be provided to selectively activatetransducer assembly (112). Buttons (126) of the present example arepositioned such that an operator may readily fully operate instrument(100) with a single hand. For instance, the operator may position theirthumb about pistol grip (124), position their middle, ring, and/orlittle finger about trigger (128), and manipulate buttons (126) usingtheir index finger. Of course, any other suitable techniques may be usedto grip and operate instrument (100); and buttons (126) may be locatedat any other suitable positions.

Shaft assembly (130) of the present example comprises an outer sheath(132), an inner tube (134) slidably disposed within outer sheath (132),and a waveguide (102) disposed within inner tube (134). As will bediscussed in more detail below inner tube (134) is operable to translatelongitudinally within outer sheath (132) relative to outer sheath (132)to selectively pivot clamp arm (144) toward and away from blade (160).Shaft assembly (130) of the present example further includes a rotationassembly (150). Rotation assembly (150) is operable to rotate the entireshaft assembly (130) and end effector (140) relative to handle assembly(120) about a longitudinal axis of shaft assembly (130). In someversions, rotation assembly (150) is operable to selectively lock theangular position of shaft assembly (130) and end effector (140) relativeto handle assembly (120) about the longitudinal axis of shaft assembly(130). For instance, a rotation knob (152) of rotation assembly (150)may be translatable between a first longitudinal position, in whichshaft assembly (130) and end effector (140) are rotatable relative tohandle assembly (120) about the longitudinal axis of shaft assembly(130); and a second longitudinal position, in which shaft assembly (130)and end effector (140) are not rotatable relative to handle assembly(120) about the longitudinal axis of shaft assembly (130). Of course,shaft assembly (130) may have a variety of other components, features,and operabilities, in addition to or in lieu of any of those notedabove. Other suitable configurations for shaft assembly (130) will beapparent to those of ordinary skill in the art in view of the teachingsherein.

As shown in FIGS. 3 and 4, end effector (140) includes ultrasonic blade(160) and clamp arm (144). Clamp arm (144) includes a clamp pad (146)secured to an underside of clamp arm (144), facing blade (160). Clamparm (144) is pivotably coupled with a distal end of outer sheath (132)of shaft assembly (130) above ultrasonic blade (160) via a pin (145). Asbest seen in FIG. 4, a distal end of inner tube (134) is rotatablycoupled with a proximal end of clamp arm (144) below ultrasonic blade(160) via a pin (135) such that longitudinal translation of inner tube(134) causes rotation of clamp arm (144) about pin (145) toward and awayfrom ultrasonic blade (160) to thereby clamp tissue between clamp arm(144) and ultrasonic blade (160) to cut and/or seal the tissue. Inparticular, proximal longitudinal translation of inner tube (134)relative to outer sheath (132) and handle assembly (120) causes clamparm (144) to move toward ultrasonic blade (160); and distal longitudinaltranslation of inner tube (134) relative to outer sheath (132) andhandle assembly (120) causes clamp arm (144) to move away fromultrasonic blade (160).

As shown in FIG. 5, and as discussed above, trigger (128) is pivotablycoupled to handle assembly (120) via a pin (123A) such that trigger(128) is operable to rotate about pin (123A). As will be described inmore detail below, trigger (128) is coupled with a yoke (125) via alinkage (129) such that rotation of trigger (128) about pin (123A)causes longitudinal translation of yoke (125). A first end (129A) oflinkage (129) is rotatably coupled with a proximal portion of trigger(128) via a pin (123B). A second end (129B) of linkage (129) isrotatably coupled with a proximal portion of yoke (125) via a pin(123C). A pair of elongate oval-shaped projections (127) extend inwardlyfrom interior surfaces of body (122). An interior surface of eachoval-shaped projection (127) defines an elongate oval-shaped slot(127A). Pin (123C) passes completely through the proximal portion ofyoke (125) and second end (129B) of linkage (129) such that ends of pin(123C) extend from opposite sides of yoke (125). These ends of pin(123C) are slidably and rotatably disposed within oval-shaped slots(127A). A pin (123D) passes completely through a distal portion of yoke(125) such that ends of pin (123D) extend from opposite sides of yoke(125). These ends of pin (123D) are slidably and rotatably disposedwithin oval-shaped slots (127A). It should therefore be understood thatyoke (125) is longitudinally translatable within oval-shaped slots(127A) via pins (123C, 123D) between a proximal longitudinal positionand a distal longitudinal position. Furthermore, because the proximalportion of trigger (128) is coupled with yoke (125) via linkage (129),pivoting of trigger (128) toward and away from pistol grip (124) willcause longitudinal translation of yoke (125) within oval-shaped slots(127A). In particular, pivoting of trigger (128) toward pistol grip(124) will cause proximal longitudinal translation of yoke (125) withinoval-shaped slots (127A); and that pivoting of trigger (128) away frompistol grip (124) will cause distal longitudinal translation of yoke(125) within oval-shaped slots (127A).

A distal portion of yoke (125) is coupled with inner tube (134) of shaftassembly (130) via a coupling assembly (135). As discussed above, innertube (134) is longitudinally translatable within outer sheath (132),such that inner tube (134) is configured to longitudinally translateconcurrently with yoke (125). Furthermore, because pivoting of trigger(128) toward pistol grip (124) causes proximal longitudinal translationof yoke (125), it should be understood that pivoting of trigger (128)toward pistol grip (124) will cause proximal longitudinal translation ofinner tube (134) relative to outer sheath (132) and handle assembly(120); and because pivoting of trigger (128) away from pistol grip (124)causes distal longitudinal translation of yoke (125), it should beunderstood that and that pivoting of trigger (128) away from pistol grip(124) will cause distal longitudinal translation of inner tube (134)relative to outer sheath (132) and handle assembly (120). Finally,because longitudinal translation of inner tube (134) causes rotation ofclamp arm (144) toward and away from blade (160) as discussed above, itshould be understood that pivoting of trigger (128) toward pistol grip(124) will cause clamp arm (144) to move toward ultrasonic blade (160);and that pivoting of trigger (128) away from pistol grip (124) willcause clamp arm (144) to move away from ultrasonic blade (160).

In some versions, one or more resilient members are used to bias clamparm (144) and/or trigger (128) to the open position shown in FIG. 4. Forinstance, as shown in FIG. 5, a spring (136) is positioned within aproximal end of body (122) of handle assembly (120). Spring (136) bearsagainst body (122) and a proximal end of yoke (125) to thereby bias yoke(125) toward the distal position. Biasing of yoke (125) toward thedistal position causes inner tube (134) to be biased distally andfurther causes trigger (128) to be biased away from pistol grip (124).

The foregoing components and operabilities of instrument (100) aremerely illustrative. Instrument (100) may be configured in numerousother ways as will be apparent to those of ordinary skill in the art inview of the teachings herein. By way of example only, at least part ofinstrument (100) may be constructed and/or operable in accordance withat least some of the teachings of any of the following, the disclosuresof which are all incorporated by reference herein: U.S. Pat. Nos.5,322,055; 5,873,873; 5,980,510; 6,325,811; 6,783,524; U.S. Pub. No.2006/0079874; U.S. Pub. No. 2007/0191713; U.S. Pub. No. 2007/0282333;U.S. Pub. No. 2008/0200940; U.S. Pub. No. 2010/0069940; U.S. Pub. No.2011/0015660; U.S. Pub. No. 2012/0112687; U.S. Pub. No. 2012/0116265;U.S. Pub. No. 2014/0005701; and/or U.S. Pub. No. 2014/0114334.Additional merely illustrative variations for instrument (100) will bedescribed in greater detail below. It should be understood that thebelow described variations may be readily applied to instrument (100)described above and any of the instruments referred to in any of thereferences that are cited herein, among others.

III. EXEMPLARY ULTRASONIC SURGICAL INSTRUMENT WITH DUAL MODES

In some instances, it may be desirable to provide instruments (20, 100)with features configured to allow an operator to selectively seal orweld tissue (e.g., a blood vessel, etc.) without cutting the tissue(“seal-only” mode) or cut tissue and seal or weld tissue substantiallysimultaneously (“cut-and-seal” mode). One merely exemplary way in whichto provide such selective operation to instruments (20, 100) is toprovide instrument (100) with features operable to selectively increaseand/or decrease a pressure applied to tissue by blades (24, 160). Forinstance, instrument (100) may be provided with features operable toselectively increase and/or decrease a clamping pressure applied totissue between clamp arm (144) and blade (160). The examples describedbelow provide various examples of features and techniques configured toallow an operator to selectively seal or weld tissue without cutting thetissue or cut tissue and seal or weld tissue substantiallysimultaneously. In other words, the examples described below providevarious examples of features and techniques that enable an operator toselectively switch a variation of instrument (20, 100) between two modesof operation—a seal-only mode and a cut-and-seal mode. While variousexamples of features operable to provide such selective operation ininstruments (20, 100) will be described in greater detail below, otherexamples will be apparent to those of ordinary skill in the artaccording to the teachings herein. Similarly, various suitable ways inwhich the below teachings may be combined with the teachings of thevarious references cited herein will be apparent to those of ordinaryskill in the art.

The examples provided below are directed mainly to mechanical featuresthat provide two modes of operation—a seal-only mode and a cut-and-sealmode. In addition to the mechanical aspects of these two modes asdescribed below, it should be understood that the below describedvariations of instrument (20, 100) may also provide different ultrasonicactivation based on whether the instrument is in a seal-only mode or acut-and-seal mode. For instance, if the instrument is in a seal-onlymode, generator (116) may activate transducer assembly (112) to causeblade (24, 160) to vibrate with ultrasonic characteristics that aretuned or optimized to just sealing tissue. If the instrument is in acut-and-seal mode, generator (116) may activate transducer assembly(112) to cause blade (24, 160) to vibrate with ultrasoniccharacteristics that are tuned or optimized to cut tissue. In versionswhere movement of one or more mechanical features provide a transitionbetween the seal-only mode and the cut-and-seal mode, one or moresensors may detect such movement to thereby detect the transitionsbetween the seal-only mode and the cut-and-seal mode. Generator (116)may be in communication with such sensors, such that generator (116) mayalter the ultrasonic characteristics of blade (24, 160) based oninformation from such sensors. Various suitable ways in which theoperation of generator (116) and/or blade (24, 160) may vary inaccordance with transitions between a seal-only mode and a cut-and-sealmode will be apparent to those of ordinary skill in the art in view ofthe teachings herein. Similarly, various suitable ways in which feedbackmay be provided to generator (116) to indicate transitions between aseal-only mode and a cut-and-seal mode will be apparent to those ofordinary skill in the art in view of the teachings herein.

A. Exemplary Ultrasonic Surgical Instrument with Elongate Pivot Arm

FIGS. 6-19C illustrate an exemplary ultrasonic surgical instrument (200)that is configured to operate substantially similar to instrument (100)discussed above except for the differences discussed below. Instrument(200) of the present example comprises a handle assembly (220), a shaftassembly (230), and an end effector (240). Handle assembly (220)comprises a body (222) including a pistol grip (224) and a pair ofbuttons (226). Handle assembly (220) also includes a trigger (228) thatis pivotable toward and away from pistol grip (224). End effector (240)includes an ultrasonic blade (260) and a pivoting clamp arm (244). Blade(260) is positioned at the distal end of an acoustic waveguide (202),which mechanically and acoustically couples an ultrasonic transducer(not shown) with blade (260). Waveguide (202) is secured within shaftassembly (230) via a pin (231), which passes through waveguide (202) andshaft assembly (230). Pin (231) is located at a position along thelength of waveguide (202) corresponding to a node associated withresonant ultrasonic vibrations communicated through waveguide (202).Clamp arm (244) is coupled with trigger (228) such that clamp arm (244)is pivotable toward ultrasonic blade (260) in response to pivoting oftrigger (228) toward pistol grip (224); and such that clamp arm (244) ispivotable away from ultrasonic blade (260) in response to pivoting oftrigger (228) away from pistol grip (224). In some versions, one or moreresilient members are used to bias clamp arm (244) and/or trigger (228)to an open position.

Shaft assembly (230) of the present example comprises an outer sheath(232), an inner tube (234), and a pivot tube (270). Outer sheath (232)is secured to waveguide (202) via pin (231). Inner tube (234) isslidably disposed within outer sheath (232). As with shaft assembly(130) discussed above, inner tube (234) is operable to translatelongitudinally within outer sheath (232) relative to outer sheath (232)to selectively pivot clamp arm (244) toward and away from blade (260).Pivot tube (270) is slidably disposed about outer sheath (232) such thatpivot tube (270) is operable to translate longitudinally about outersheath (232) relative to outer sheath (232) and handle assembly (220).Shaft assembly (230) further comprises a pivot arm assembly (280). Pivotarm assembly (280) is pivotably coupled with outer sheath (232). Pivotarm assembly (280) is further pivotably and slidably coupled with pivottube (270). As will be discussed in more detail below, pivot tube (270)is operable to translate longitudinally about outer sheath (232)relative to outer sheath (232) and handle assembly (220) to selectivelyrotate pivot arm assembly (280) about outer sheath (232) to therebytranslate clamp arm (244) vertically toward and away from blade (260).As will also be discussed in more detail below, a transition from (i)pivotal movement of clamp arm (244) about pin (245) toward blade (260)to (ii) pivotal movement of clamp arm (244) about pins (237) towardblade (260) will selectively change instrument (200) between a (i)“seal-only” operation and a (ii) “cut-and-seal” operation. FIGS. 18A-18Bshow a sequence where clamp arm (244) pivots about pin (245) towardblade (260). FIGS. 18B-18C show a sequence where clamp arm (244) pivotsabout pins (237) toward blade (260). When viewed so closely to endeffector (240) as shown in FIGS. 18B-18C, this pivotal movement of clamparm (244) about pins (237) may appear to be simply verticaltranslational movement of clamp arm (244) toward pins (237). This is dueto pins (237) providing fulcrum/pivot points that are substantiallyspaced away from clamp arm (244). It should be understood that thispivotal movement about pins (237), or “apparent vertical translation,”of clamp arm (244) toward and away from blade (260) is along a path thatis substantially perpendicular to a longitudinal axis defined by shaftassembly (230).

As best seen in FIG. 9, end effector (240) of the present examplecomprises clamp arm (244) and ultrasonic blade (260). Clamp arm (244)includes a primary clamp pad (246) and a secondary clamp pad (248) thatare secured to an underside of clamp arm (244), facing blade (260).Clamp arm (244) is operable to selectively pivot toward and away fromblade (260) to selectively clamp tissue between clamp pads (246, 248)and blade (260). As will be discussed in more detail below, clamp arm(244) is pivotably coupled with a distal end of a semi-cylindricalmember (282), which is a portion of clamp arm assembly (280) positionedadjacent to a top surface of outer sheath (232), via a pin (245). Clamparm (244) is operable to rotate about pin (245). A distal end of innertube (234) is rotatably and slidably coupled with a proximal end ofclamp arm (244) via a pair of pins (235). Each pin (235) is disposedwithin a respective slot (233) formed in a distal end of inner tube(234) such that longitudinal translation of inner tube (234) relative toouter sheath (232) and pivot arm assembly (280) causes rotation of clamparm (244) about pin (245) toward and away from ultrasonic blade (260) tothereby clamp tissue between clamp pads (246, 248) and ultrasonic blade(260) to cut and/or seal the tissue. In particular, proximallongitudinal translation of inner tube (234) relative to outer sheath(232) and pivot arm assembly (280) causes clamp arm (244) to rotateabout pin (245) toward ultrasonic blade (260); and distal longitudinaltranslation of inner tube (234) relative to outer sheath (232) and pivotarm assembly (280) causes clamp arm (244) to rotate about pin (245) awayfrom ultrasonic blade (260).

As mentioned above, the distal end of inner tube (234) is slidablycoupled with the proximal end of clamp arm (244) via pins (235) disposedwithin slots (233). Pins (235) are operable to translate verticallywithin the respective slots (233) such that clamp arm (244) is operableto pivot about pins (237) between an upward vertical position (FIGS.18A-18B) and a downward vertical position (FIG. 18C). As will bediscussed in more detail below, rotation of pivot arm assembly (280)causes this pivotal movement of clamp arm (244) about pins (237) tothereby clamp tissue between clamp pads (246, 248) and ultrasonic blade(260) to cut and/or seal the tissue. In particular, counter-clockwiserotation of pivot arm assembly (280) relative to outer sheath (232) andinner tube (234) causes clamp arm (244) to pivot about pins (237)downwardly toward ultrasonic blade (260); and clockwise rotation ofpivot arm assembly (280) relative to outer sheath (232) and inner tube(234) causes clamp arm (244) to pivot about pins (237) upwardly awayfrom ultrasonic blade (260). As noted above, this motion of clamp arm(244) is nearly vertical, such that it may appear that clamp arm (244)is translating vertically relative to blade (260).

As best seen in FIGS. 11 and 12, pivot arm assembly (280) comprises asemi-cylindrical member (282) and a pair of elongate-plate members(284). Elongate-plate members (284) extend proximally from a proximalend of semi-cylindrical member (282) parallel to one another such that agap is defined between interior surfaces of elongate-plate members(284). Shaft assembly (230) is configured to be received within this gapsuch that elongate-plate members (284) are at least partially disposedabout outer sheath (232) and pivot tube (270). Pivot arm assembly (280)further includes a pair of pinholes (285) formed in a distal portion ofelongate-plate members (284). As best seen in FIG. 14, outer sheath(232) comprises a pair of pins (237) extending transversely from anexterior surface of outer sheath (232). Pins (237) are configured to bepivotably received within pinholes (285) of elongate-plate members (284)such that pivot arm assembly (280) is pivotably coupled with outersheath (232) and such that pivot arm assembly (280) is operable torotate about pins (237) of outer sheath (232). As best seen in FIG. 8,pivot arm assembly (280) is coupled with outer sheath (232) such thatsemi-cylindrical member (282) is positioned adjacent to a top surface ofouter sheath (232). A proximal portion of semi-cylindrical member (282)comprises a semi-circular recess (283) formed therein such that at leasta portion of outer sheath (232) may be received within semi-cylindricalmember (282) as pivot arm assembly (280) rotates about pins (237).

Pivot arm assembly (280) further includes a pair of slots (287) formedin a proximal portion of elongate-plate members (284). As best seen inFIG. 13, pivot tube (270) comprises a pair of pins (272) extending froman exterior surface of pivot tube (270). Pins (272) are slidably andpivotably received within slots (287) of elongate-plate members (284)such that pivot arm assembly (280) is pivotably and slidably coupledwith pivot tube (270). As best seen in FIG. 12, slots (287) include adistal portion (287A), a proximal portion (287C), and an intermediateportion (287B). Portions (287A, 287B, 287C) together provide a doglegconfiguration. Distal portion (287A) is formed in a top portion ofelongate-plate members (284) and is slightly angled obliquely relativeto the longitudinal axis of elongate-plate members (284) such that, aswill be discussed in more detail below, with pivot arm assembly (280)oriented at a similar angle, distal portion (287A) is substantiallyhorizontal. Proximal portion (287C) is formed in a bottom portion ofelongate-plate members (284) and is also slightly angled obliquelyrelative to the longitudinal axis of elongate-plate members (284) suchthat, as will be discussed in more detail below, with pivot arm assembly(280) oriented at a similar angle, proximal portion (287C) issubstantially horizontal. Finally, intermediate portion (287B) is alsoangled obliquely relative to the longitudinal axis of elongate-platemembers (284) and provides for angular transition between a proximal endof distal portion (287A) and a distal end of proximal portion (287C).

As will be discussed in more detail below, pivot tube (270) is operableto translate longitudinally about outer sheath (232), relative to outersheath (232) and handle assembly (220), so as to cause translation ofpins (272) within slots (287) to thereby selectively rotate pivot armassembly (280) about pins (237) of outer sheath (232). In particular,proximal longitudinal translation of pivot tube (270) relative to outersheath (232) and handle assembly (220) causes counter-clockwise rotationof pivot arm assembly (280) about pins (237) of outer sheath (232); anddistal longitudinal translation of pivot tube (270) relative to outersheath (232) and handle assembly (220) causes clockwise rotation ofpivot arm assembly (280) about pins (237) of outer sheath (232).

Pivot arm assembly (280) further comprises a projection (286) extendingdistally from a distal end of semi-cylindrical member (282). Clamp arm(244) is pivotably coupled with projection (286) of pivot arm assembly(280) via pin (245) such that, as discussed above, rotation of pivot armassembly (280) about pins (237) of outer sheath (232) causes nearly ormostly vertical translation of clamp arm (244) within slot (233). Inparticular, counter-clockwise rotation of pivot arm assembly (280) aboutpins (237) of outer sheath (232) causes clamp arm (244) to translatenearly or mostly vertically downwardly toward ultrasonic blade (260);and clockwise rotation of pivot arm assembly (280) about pins (237) ofouter sheath (232) causes clamp arm (244) to translate nearly or mostlyvertically upwardly away from ultrasonic blade (260). It shouldtherefore be understood that proximal longitudinal translation of pivottube (270) relative to outer sheath (232) and handle assembly (220)causes counter-clockwise rotation of pivot arm assembly (280) about pins(237) of outer sheath (232), which in turn causes clamp arm (244) totranslate nearly or mostly vertically downwardly toward ultrasonic blade(260); and distal longitudinal translation of pivot tube (270) relativeto outer sheath (232) and handle assembly (220) causes clockwiserotation of pivot arm assembly (280) about pins (237) of outer sheath(232), which in turn causes clamp arm (244) to translate nearly ormostly vertically upwardly away from ultrasonic blade (260). Again, themovement of clamp arm (244) is not exactly vertical because clamp arm(244) is actually pivoting about pins (237), though the motion mayappear to be vertical because pins (237) are spaced so far proximal ofclamp arm (244).

As shown in FIG. 16, trigger (228) is pivotably coupled to handleassembly (220) via a pin (223A) such that trigger (228) is operable torotate about pin (223A). As will be described in more detail below,trigger (228) is coupled with a yoke (225) via a linkage (229) such thatrotation of trigger (228) about pin (223A) causes longitudinaltranslation of yoke (225). A first end (229A) of linkage (229) isrotatably coupled with a proximal portion of trigger (228) via a pin(223B). A second end (229B) of linkage (229) is rotatably coupled with aproximal portion of yoke (225) via a pin (223C). Pin (223C) passescompletely through the proximal portion of yoke (225) and second end(229B) of linkage (229) such that ends of pin (223C) extend fromopposite sides of yoke (225). These ends of pin (223C) are slidably androtatably disposed within slots (not shown) formed in interior surfacesof body (222) of handle assembly (220). A pin (223D) passes completelythrough a distal portion of yoke (225) such that ends of pin (223D)extend from opposite sides of yoke (225). These ends of pin (223D) arealso slidably and rotatably disposed within the slots formed in theinterior surfaces of body (222). Pins (223C, 223D) are thus configuredto longitudinally translate within these slots in body (222). Thisslidability of pins (223C, 223D) enables yoke (225) to longitudinallytranslate within body (222) between a proximal longitudinal position anda distal longitudinal position. Because the proximal portion of trigger(228) is coupled with yoke (225) via linkage (229), pivoting of trigger(228) toward and away from pistol grip (224) will cause longitudinaltranslation of yoke (225) within body (222). In particular, pivoting oftrigger (228) toward pistol grip (224) will cause proximal longitudinaltranslation of yoke (225); and pivoting of trigger (228) away frompistol grip (224) will cause distal longitudinal translation of yoke(225).

A distal portion of yoke (225) engages a flange (274) of pivot tube(270) such that longitudinal translation of yoke (225) causes concurrentlongitudinal translation of pivot tube (270). The distal portion of yoke(225) further engages an integral flange (276) of inner tube (234) via aplurality of wave springs (241) that are disposed between yoke (225) andflange (276) of inner tube (234) such that longitudinal translation ofyoke (225) causes concurrent longitudinal translation of pivot tube(270). As discussed above, inner tube (234) is longitudinallytranslatable within outer sheath (232), such that inner tube (234) isconfigured to longitudinally translate concurrently with yoke (225).Also as discussed above, pivot tube (270) is longitudinally translatableabout outer sheath (232), such that pivot tube (270) is configured tolongitudinally translate concurrently with yoke (225). Furthermore,because pivoting of trigger (228) toward pistol grip (224) causesproximal longitudinal translation of yoke (225), it should be understoodthat pivoting of trigger (228) toward pistol grip (224) will causeproximal longitudinal translation of inner tube (234) and pivot tube(270) relative to outer sheath (232) and handle assembly (220).Similarly, because pivoting of trigger (228) away from pistol grip (224)causes distal longitudinal translation of yoke (225), it should beunderstood that and that pivoting of trigger (228) away from pistol grip(224) will cause distal longitudinal translation of inner tube (234) andpivot tube (270) relative to outer sheath (232) and handle assembly(220). Because longitudinal translation of inner tube (234) causesrotation of clamp arm (244) toward and away from blade (260) asdiscussed above, it should be understood that pivoting of trigger (228)toward pistol grip (224) will cause clamp arm (244) to move towardultrasonic blade (260). Similarly, pivoting of trigger (228) away frompistol grip (224) will cause clamp arm (244) to move away fromultrasonic blade (260). Finally, because longitudinal translation ofpivot tube (270) causes rotation of pivot arm assembly (280) asdiscussed above, it should be understood that pivoting of trigger (228)toward pistol grip (224) will cause counter-clockwise rotation of pivotarm assembly (280) about pins (237). Similarly, pivoting of trigger(228) away from pistol grip (224) will cause clockwise rotation of pivotarm assembly (280) about pins (237).

However, as will be discussed in more detail below, longitudinaltranslation of inner tube (234) is limited by pin (231)—which secureswaveguide (202) within shaft assembly (230) via outer sheath (232)—suchthat pivoting of trigger (228) toward pistol grip (224) beyond apredetermined point does not cause proximal longitudinal translation ofinner tube (234). In particular, pin (231) passes through a longitudinalslot (239) formed in inner tube (234) (best seen in FIG. 10) such thatinner tube (234) is operable to translate no more than the length ofslot (239).

In some versions, one or more resilient members are used to bias clamparm (244), pivot arm assembly (280), and/or trigger (228) to the openposition shown in FIG. 7. For instance, as best seen in FIG. 16, aspring (236) is positioned within a proximal end of body (222) of handleassembly (220). Spring (236) bears against body (222) and a proximal endof yoke (225) to thereby bias yoke (225) toward the distal position.Biasing of yoke (225) toward the distal position causes inner tube (234)and pivot tube (270) to be biased distally and further causes trigger(228) to be biased away from pistol grip (224).

FIGS. 17A-19C show the operation of instrument (200). FIG. 17A shows endeffector (240) and shaft assembly (270) in an initial position. In thisposition, inner tube (234) is in a distal longitudinal position relativeto outer sheath (232) and handle assembly (220) such that clamp arm(244) is in an open position. Also in this initial position, pivot tube(270) is in a distal longitudinal position relative to outer sheath(232) and handle assembly (220) such that pins (272) are positionedwithin a distal end of distal portion (287A) of slots (287), such thatpivot arm assembly (280) is in a first rotational position. As best seenin FIG. 18A, with pivot arm assembly (280) in the first rotationalposition, pins (235) of clamp arm (244) are in an upward verticalposition within slots (233) of inner tube (234).

FIG. 19A shows shaft assembly (230) and handle assembly (220) in theinitial position. In this position, trigger (228) is in a firstrotational position away from pistol grip (224) such that yoke (225) isin a distal longitudinal position. As trigger (228) is rotated towardpistol grip (224) to a second rotational position, yoke (225) istranslated longitudinally proximally as shown in FIG. 19B. As discussedabove, proximal longitudinal translation of yoke (225) causes proximallongitudinal translation of inner tube (234) and pivot tube (270)relative to outer sheath (232) and relative to handle assembly (220). Aspivot tube (270) is translated longitudinally proximally by rotation oftrigger (228) from the first rotational position (FIG. 19A) to thesecond rotational position (FIG. 19B), pins (272) of pivot tube (270)translate within slots (287) from the distal end of distal portion(287A) to the proximal end of distal portion (287A). As shown in FIG.17A, and as discussed above, distal portion (287A) is slightly angledrelative to elongate-plate members (284) such that distal portion (287A)is substantially horizontal with pivot arm assembly (280) in the firstrotational position. It should therefore be understood that as pivottube (270) is translated longitudinally proximally by rotation oftrigger (228) through a first range of motion from the first rotationalposition (FIG. 19A) to the second rotational position (FIG. 19B), pins(272) translate within distal portion (287A) of slots (287) withoutcausing substantial rotation of pivot arm assembly (280). Becauserotation of pivot arm assembly (280) causes nearly or mostly verticaltranslation of clamp arm (244), it should be appreciated that clamp arm(244) remains in the upward vertical position within slot (233) of innertube (234) as trigger (228) rotates through the first range of motionfrom the first rotational position (FIG. 19A) to the second rotationalposition (FIG. 19B).

As inner tube (234) is translated longitudinally proximally by rotationof trigger (228) from the first rotational position (FIG. 19A) to thesecond rotational position (FIG. 19B), inner tube (234) causes clamp arm(244) to pivot toward ultrasonic blade (260) into a partially closed, or“seal-only,” position. In this “seal-only” position, clamp arm (244) isoriented substantially parallel to blade (260). Because, as discussedabove, clamp arm (244) remains in the upward vertical position withinslot (233) of inner tube (234) a gap (G) remains between clamp pads(246, 248) and blade (260), as best seen in FIG. 18B. Gap (G) betweenclamp pads (246, 248) and blade (260) is configured to minimize aclamping pressure applied to tissue captured between clamp arm (244) andblade (260) such that blade (260) is operable to seal or weld thetissue, but not cut the tissue in this position. It should beappreciated that handle assembly (220), shaft assembly (230), and/or endeffector (240) may include features that are configured to providetactile or auditory feedback to the operator to signal that clamp arm(244) has reached this “seal-only” position. Furthermore, as inner tube(234) is translated longitudinally proximally by rotation of trigger(228) through the first range of motion from the first rotationalposition (FIG. 19A) to the second rotational position (FIG. 19B), pin(231) translates within slot (239) of inner tube (234) from a proximalend of slot (239) to a distal end of slot (239) such that inner tube(234) is inoperable to translate further proximally. Thus, because innertube (234) is inoperable to translate further longitudinally proximally,it should be understood that clamp arm (244) is inoperable to pivotfurther toward ultrasonic blade (260) at this stage. It should also beappreciated that wave springs (241) will accommodate furtherlongitudinal translation of yoke (225).

As trigger (228) is rotated further toward pistol grip (224) through asecond range of motion to a third rotation position, yoke (225) isfurther translated longitudinally proximally as shown in FIG. 19C.Further proximal longitudinal translation of yoke (225) causes furtherproximal longitudinal translation of pivot tube (270) relative to outersheath (232) and handle assembly (220). As pivot tube (270) is furthertranslated longitudinally proximally, pins (272) translate proximallywithin intermediate portion (287B) of slots (287) between the proximalend of distal portion (287A) and the distal end of proximal portion(287C). As pins (272) translate within slots (287), pivot arm assembly(280) is rotated counter-clockwise about pins (237) into a secondrotational position as shown in FIG. 17C. As pivot arm assembly (280) isrotated counter-clockwise about pins (237), clamp arm (244) istranslated nearly or mostly vertically downwardly into the downwardvertical position as pins (235) travel downwardly within slots (233) ofinner tube (234) into a completely closed, or “cut-and-seal,” position.In particular, clamp arm (244)—while remaining oriented substantiallyparallel to blade (260)—is translated nearly or mostly verticallydownwardly toward blade (260) so as to increase pressure applied totissue captured between clamp arm (244) and blade (260) such that blade(260) is operable to substantially simultaneously cut and seal or weldthe tissue. It should be appreciated that handle assembly (220), shaftassembly (230), and/or end effector (240) may include features that areconfigured to provide tactile or auditory feedback to the operator tosignal that clamp arm (244) has reached this “seal-and-cut” position.

As shown in FIG. 17C, and as discussed above, proximal portion (287C) isslightly angled relative to elongate-plate members (284) such thatproximal portion (287C) is substantially horizontal with pivot armassembly (280) in the second rotational position. It should therefore beunderstood that as pivot tube (270) is further translated longitudinallyproximally by rotation of trigger (228) beyond the third rotationalposition (FIG. 19C), pins (272) translate within proximal portion (287C)of slots (287) without causing substantial rotation of pivot armassembly (280). Because rotation of pivot arm assembly (280) causesvertical translation of clamp arm (244), it should be appreciated thatclamp arm (244) remains in the downward vertical position if trigger(228) rotates beyond the third rotational position (FIG. 19C).

When the operator relaxes their grip on trigger (228) or otherwise movestrigger (228) away from grip (224), trigger (228) may eventually returnto the position shown in FIG. 19A. As trigger (228) travels through thisrange of motion, pivot arm assembly (280) rotates clockwise back fromthe position shown in FIG. 17C to the position shown in FIG. 17B,returning clamp arm (244) from the downward position shown in FIG. 18Cto the upward position shown in FIG. 18B. In addition, inner tube (234)translates distally from the position shown in FIGS. 17B-17C to theposition shown in FIG. 17A, returning clamp arm (244) back to the fullyopen position shown in FIG. 18A.

B. Exemplary Ultrasonic Surgical Instrument with Shortened Pivot Arm

FIG. 20 depicts an exemplary shaft assembly (330) and end effector (340)that may be readily incorporated into instrument (200) in place of shaftassembly (230) and end effector (240). Shaft assembly (330) and endeffector (340) are configured to operate substantially similar to shaftassembly (230) and end effector (240) discussed above except for thedifferences discussed below. In particular, shaft assembly (330) and endeffector (340) are configured to selectively clamp tissue between aclamp arm (344) and an ultrasonic blade (360) of end effector (340) in a“seal-only” operation, in which blade (360) is operable to seal or weldtissue without cutting the tissue; and in a “cut-and-seal” operation, inwhich blade (360) is operable to cut tissue and seal or weld tissuesubstantially simultaneously.

Shaft assembly (330) of the present example comprises an outer sheath(332), an inner tube (334), a pivot tube (370), and a pivot arm assembly(380). Inner tube (334) is slidably disposed within outer sheath (332).As with shaft assembly (230) discussed above, inner tube (334) isoperable to translate longitudinally within outer sheath (332) relativeto outer sheath (332) to selectively pivot clamp arm (344) toward andaway from blade (360). Pivot tube (370) is slidably disposed about outersheath (332) such that pivot tube (370) is operable to translatelongitudinally about outer sheath (332) relative to outer sheath (332).Pivot arm assembly (380) is pivotably coupled with outer sheath (332).Pivot arm assembly (380) is further pivotably and slidably coupled withpivot tube (370). Pivot tube (370) of the present example, however, issubstantially longer than pivot tube (270) discussed above; and pivotarm assembly (380) of the present example is substantially shorter thanpivot arm assembly (280) discussed above. Thus, pivot arm assembly (380)is coupled with pivot tube (370) at a distal end of shaft assembly(230). As with pivot tube (270) discussed above, pivot tube (370) isoperable to translate longitudinally about outer sheath (332) relativeto outer sheath (332) to selectively rotate pivot arm assembly (380)about outer sheath (332) to thereby translate clamp arm (344) nearly ormostly vertically toward and away from blade (360) via a slot (333)formed within a distal end of inner tube (334). It should there beunderstood that, as with shaft assembly (230) and end effector (240)discussed above, a combination of rotation and nearly or mostly verticaltranslation of clamp arm (344) relative to blade (360) is configured toselectively change instrument (300) between a “seal-only” operation anda “cut-and-seal” operation.

End effector (340) of the present example comprises clamp arm (344) andultrasonic blade (360). Clamp arm (344) includes a primary clamp pad(346) and a secondary clamp pad (348) that are secured to an undersideof clamp arm (344), facing blade (360). Clamp arm (344) is operable toselectively pivot toward and away from blade (360) to selectively clamptissue between clamp pads (346, 348) and blade (360). As will bediscussed in more detail below, clamp arm (344) is pivotably coupledwith a distal end of pivot arm assembly (380) via a pin (345) such thatclamp arm (344) is operable to rotate about the distal end of pivot armassembly (380). A distal end of inner tube (334) is rotatably andslidably coupled with a proximal end of clamp arm (344) via a pair ofpins (335) that are disposed within respective slots (333) that areformed in a distal end of inner tube (334) such that longitudinaltranslation of inner tube (334) relative to sheath (332) causes rotationof clamp arm (344) about the distal end of pivot arm assembly (380)toward and away from ultrasonic blade (360) to thereby clamp tissuebetween clamp pads (346, 348) and ultrasonic blade (360) to cut and/orseal the tissue. In particular, proximal longitudinal translation ofinner tube (334) relative to outer sheath (332) causes clamp arm (344)to rotate about the distal end of pivot arm assembly (380) via pin (345)toward ultrasonic blade (360); and distal longitudinal translation ofinner tube (334) relative to outer sheath (332) causes clamp arm (344)to rotate about the distal end of pivot arm assembly (380) via pin (345)away from ultrasonic blade (360).

As mentioned above, the distal end of inner tube (334) is slidablycoupled with the proximal end of clamp arm (344) via pins (335) disposedwithin slots (333) such that clamp arm (344) is operable to translatevertically within slot (333) between an upward vertical position and adownward vertical position. As will be discussed in more detail below,rotation of pivot arm assembly (380) causes vertical translation ofclamp arm (344) toward ultrasonic blade (360) to thereby clamp tissuebetween clamp pads (346, 348) and ultrasonic blade (360) to cut and/orseal the tissue. In particular, counter-clockwise rotation of pivot armassembly (380) about outer sheath (332) causes clamp arm (344) totranslate vertically downwardly toward ultrasonic blade (360); andclockwise rotation of pivot arm assembly (380) about outer sheath (332)causes clamp arm (344) to translate vertically upwardly away fromultrasonic blade (360).

As with pivot arm assembly (280) discussed above, pivot arm assembly(380) comprises a semi-cylindrical member (382) and a pair ofelongate-plate members (384). Elongate-plate members (384) extendproximally from a proximal end of semi-cylindrical member (382) andparallel to one another such that a gap is defined between interiorsurfaces of elongate-plate members (384). Shaft assembly (330) isconfigured to be received within this gap such that elongate-platemembers (384) are at least partially disposed about outer sheath (332)and pivot tube (370). Pivot arm assembly (380) further comprises a pairof pinholes (385) formed in a proximal portion of semi-cylindricalmember (382). Outer sheath (332) comprises a pair of pins (337)extending transversely from an exterior surface of a distal end of outersheath (332). Pins (337) are pivotably received within pinholes (385) ofsemi-cylindrical member (382) such that pivot arm assembly (380) ispivotably coupled with the distal end of outer sheath (332) and suchthat pivot arm assembly (380) is operable to rotate about pins (337) ofouter sheath (332).

Pivot arm assembly (380) further includes a pair of slots (387) formedin a proximal portion of elongate-plate members (384). Pivot tube (370)comprises a pair of pins (372) extending from an exterior surface ofpivot tube (370). Pins (372) are slidably and pivotably received withinslots (387) of elongate-plate members (384) such that pivot arm assembly(380) is pivotably and slidably coupled with pivot tube (370). Slots(387) include a distal portion (387A), a proximal portion (387C), and anintermediate portion (387B). Distal portion (387A) is formed in a topportion of elongate-plate members (384) and is slightly angled obliquelyrelative to elongate-plate members (384) such that, with pivot armassembly (380) oriented at a similar angle, distal portion (387A) issubstantially horizontal. Proximal portion (387C) is formed in a bottomportion of elongate-plate members (384) and is also slightly angledobliquely relative to elongate-plate members (384) such that, with pivotarm assembly (380) oriented at a similar angle, proximal portion (387C)is substantially horizontal. Finally, intermediate portion (387B) isalso angled relative to elongate-plate members (384) and provides forangular transition between a proximal end of distal portion (387A) and adistal end of proximal portion (387C). As with pivot tube (270)discussed above, pivot tube (370) is operable to translatelongitudinally about outer sheath (332) relative to outer sheath (332)so as to cause translation of pins (372) within slots (387) to therebyselectively rotate pivot arm assembly (380) about pins (337) of outersheath (332). In particular, proximal longitudinal translation of pivottube (370) relative to outer sheath (332) causes counter-clockwiserotation of pivot arm assembly (380) about pins (337) of outer sheath(332); and distal longitudinal translation of pivot tube (370) relativeto outer sheath (332) causes clockwise rotation of pivot arm assembly(380) about pins (337) of outer sheath (332).

Clamp arm (344) is pivotably coupled with a distal end ofsemi-cylindrical member (382) of pivot arm assembly (380) via pin (345)such that, as discussed above, rotation of pivot arm assembly (380)about pins (337) of outer sheath (332) causes nearly or mostly verticaltranslation of clamp arm (344) within slot (333). In particular,counter-clockwise rotation of pivot arm assembly (380) about pins (337)of outer sheath (332) causes clamp arm (344) to translate nearly ormostly vertically downwardly toward ultrasonic blade (360); andclockwise rotation of pivot arm assembly (380) about pins (337) of outersheath (332) causes clamp arm (344) to translate nearly or mostlyvertically upwardly away from ultrasonic blade (360). It shouldtherefore be understood that proximal longitudinal translation of pivottube (370) relative to outer sheath (332) causes counter-clockwiserotation of pivot arm assembly (380) about pins (337) of outer sheath(332), which in turn causes clamp arm (344) to translate nearly ormostly vertically downwardly toward ultrasonic blade (360); and distallongitudinal translation of pivot tube (370) relative to outer sheath(332) causes clockwise rotation of pivot arm assembly (380) about pins(337) of outer sheath (332), which in turn causes clamp arm (344) totranslate nearly or mostly vertically upwardly away from ultrasonicblade (360). Again, the movement of clamp arm (344) is not exactlyvertical because clamp arm (344) is actually pivoting about pins (337),though the motion may appear to be vertical because pins (337) arespaced so far proximal of clamp arm (344).

As shown in FIG. 21, shaft assembly (330) and end effector (340) may bereconfigured such that pivot arm assembly (380) is coupled directly withinner tube (334), and such that pivot tube (370) is omitted altogether.Inner tube (334) of the present example comprises a pair of pins (372)extending from an exterior surface of inner tube (334). Pins (372) arepivotably received within slots (387) of elongate-plate members (384)such that pivot arm assembly (380) is pivotably and slidably coupledwith inner tube (334). As with pivot tube (370) discussed above, innertube (334) is operable to translate longitudinally about within sheath(332) relative to outer sheath (332) so as to cause translation of pins(372) within slots (387) to thereby selectively rotate pivot armassembly (380) about pins (337) of outer sheath (332). In particular,proximal longitudinal translation of inner tube (334) relative to outersheath (332) causes counter-clockwise rotation of pivot arm assembly(380); and distal longitudinal translation of inner tube (334) relativeto outer sheath (332) causes clockwise rotation of pivot arm assembly(380). Thus, it should be that inner tube (334) is operable to translatelongitudinally within outer sheath (332) relative to outer sheath (332)to selectively pivot clamp arm (344) toward and away from blade (360)and nearly or mostly vertically translate clamp arm (344) toward andaway from blade (360). In particular, inner tube (334) is operable totranslate longitudinal within outer sheath (332) through a first rangeof longitudinal motion to pivot clamp arm (344) toward and away fromblade (360); and then through a second range of longitudinal motion tonearly or mostly vertically translate clamp arm (344) toward and awayfrom blade (360).

As shown in FIG. 21, slot (333) of inner tube (334) of the presentexample comprises a distal portion (333A). Distal portion (333A) isangled slightly obliquely relative to inner tube (334). As inner tube(334) translates longitudinally proximally through the first range ofmotion, clamp arm (344) pivots toward blade (360) and pins (372)translate within distal portion (387A) of slots (387). As inner tube(334) is further translated longitudinally proximally through the secondrange of longitudinal motion, clamp arm (344) translates nearly ormostly vertically downwardly within slot (333) into distal portion(333A) toward blade (360) as pins (372) translate within intermediateportion (387B) of slots (387) to thereby cause counter-clockwiserotation of pivot arm (360). As clamp arm (344) translates nearly ormostly vertically downwardly within slot (333) into distal portion(333A), distal portion (333A) permits proximal longitudinal translationof inner tube (334) without causing further rotation of clamp arm (344).

It should be understood from the foregoing that, regardless of whetherinstrument (200) incorporates shaft assembly (230) and end effector(240) of FIGS. 6-19C, shaft assembly (330) and end effector (340) ofFIG. 20, or shaft assembly (330) and end effector (340) of FIG. 21,instrument (200) may operate in a “seal-only” mode when trigger (228) ispivoted toward grip (224) through a first range of motion; and then in a“cut-and-seal” mode when trigger (228) is further pivoted toward grip(224) through a second range of motion. Thus, instrument (200) is eitherin the “seal-only” mode or the “cut-and-seal” mode based on theparticular pivotal position of trigger (228) relative to grip (224). Insome versions, instrument (200) transitions from the “seal-only” mode tothe “cut-and-seal” mode in a substantially seamless fashion, such thatthe user may freely and uninterruptedly continue pivoting trigger (228)toward grip (224) through the second range of motion after completingthe first range of motion. In some other versions, instrument (200) mayinclude one or more detents and/or other features that are operable toprovide tactile, audible, and/or visual feedback to indicate atransition from the first range of motion to the second range of motion(which would further indicate a transition from the “seal-only” mode tothe “cut-and-seal” mode).

In addition or in the alternative, instrument (200) may include alockout feature that requires further operator input in order to enabletrigger (228) to move through the second range of motion aftercompleting the first range of motion. By way of example only, instrument(200) may effectively block further pivotal movement of trigger (228) atthe end of the first range of motion; and may require the operator topress an additional trigger or button, etc. in order to unlock trigger(228) to thereby enable trigger (228) to move through the second rangeof motion. In some versions, handle assembly (220) includes a togglebutton that is operable to transition instrument (200) between twostates. In some such versions, trigger (228) is only able to pivotthrough the first range of motion in the first state. Upon reaching theend of the first range of motion, trigger (228) may be blocked frompivoting further. If the operator actuates the toggle button, the blockis removed, such that trigger (228) may move freely through both thefirst range of motion and the second range of motion. Other suitableways in which instrument (200) may provide a transition from the“seal-only” mode to the “cut-and-seal” mode will be apparent to those ofordinary skill in the art in view of the teachings herein.

C. Exemplary Ultrasonic Surgical Instrument with Translatable Sled

FIGS. 22-23B depict an exemplary alternative shaft assembly (430) andend effector (440) that may be readily incorporated into instrument(200) in place of shaft assembly (230) and end effector (240). Shaftassembly (430) and end effector (440) are configured to operatesubstantially similar to shaft assemblies (230, 330) and end effectors(240, 340) discussed above except for the differences discussed below.In particular, shaft assembly (430) and end effector (440) areconfigured to selectively clamp tissue between a clamp arm (444) and anultrasonic blade (460) of end effector (440) in a “seal-only” operation,in which blade (460) is operable to seal or weld tissue without cuttingthe tissue; and in a “cut-and-seal” operation, in which blade (460) isoperable to cut tissue and seal or weld tissue substantiallysimultaneously.

Shaft assembly (430) of the present example comprises an outer sheath(432), an inner tube (434), a pivot arm (480), and a translatable sled(490). Inner tube (434) is slidably disposed within outer sheath (432).As with shaft assemblies (230, 330) discussed above, inner tube (434) isoperable to translate longitudinally within outer sheath (432) relativeto outer sheath (432) to selectively pivot clamp arm (444) toward andaway from blade (460) about a pin (445). Pivot arm (480) is pivotablycoupled with outer sheath (432) via pin (437). As with pivot arms (280,380) discussed above, pivot arm (480) is operable to selectively rotateabout pin (437) relative to outer sheath (432) to thereby translateclamp arm (444) vertically toward and away from blade (460). It shouldtherefore be understood that, as with shaft assemblies (230, 330) andend effectors (240, 340) discussed above, a combination of rotation andnearly or mostly vertical translation of clamp arm (444) relative toblade (460) provides both a “seal-only” mode of operation and a“cut-and-seal” mode of operation.

End effector (440) of the present example comprises clamp arm (444) andultrasonic blade (460). Clamp arm (444) includes a primary clamp pad(446) and a secondary clamp pad (448) that are secured to an undersideof clamp arm (444), facing blade (460). Clamp arm (444) is operable toselectively pivot toward and away from blade (460) to selectively clamptissue between clamp pads (446, 448) and blade (460). As will bediscussed in more detail below, clamp arm (444) is pivotably coupledwith a distal end of pivot arm (480) via pin (445) such that clamp arm(444) is operable to rotate about the distal end of pivot arm (480) viapin (445). A distal end of inner tube (434) is rotatably and slidablycoupled with a proximal end of clamp arm (444) via pins (435), which aredisposed within respective slots (433) at the distal end of inner tube(434) such that longitudinal translation of inner tube (434) causesrotation of clamp arm (444) about the distal end of pivot arm (480)toward and away from ultrasonic blade (460) to thereby clamp tissuebetween clamp pads (446, 448) and ultrasonic blade (460) to cut and/orseal the tissue. In particular, proximal longitudinal translation ofinner tube (434) relative to outer sheath (432) and handle assembly(420) causes clamp arm (444) to rotate about pin (445) at the distal endof pivot arm (480) toward ultrasonic blade (460); and distallongitudinal translation of inner tube (434) relative to outer sheath(432) and handle assembly (420) causes clamp arm (444) to rotate aboutpin (445) at the distal end of pivot arm (480) away from ultrasonicblade (460).

As mentioned above, the distal end of inner tube (434) is slidablycoupled with the proximal end of clamp arm (444) via pins (435) disposedwithin slots (433) such that clamp arm (444) is operable to rotatebetween an upward position and a downward position. As will be discussedin more detail below, rotation of pivot arm (480) causes nearly ormostly vertical translation of pins (435) relative to slots (433) tothereby clamp tissue between clamp pads (446, 448) and ultrasonic blade(460) to cut and/or seal the tissue. In particular, counter-clockwiserotation of pivot arm (480) about outer sheath (432) causes clamp arm(444) to translate nearly or mostly vertically downwardly towardultrasonic blade (460) as pins (435) travel downwardly in slots (433);and clockwise rotation of pivot arm (480) about outer sheath (432)causes clamp arm (444) to translate nearly or mostly vertically upwardlyaway from ultrasonic blade (460) as pins (435) travel upwardly in slots(433).

Pivot arm (480) of the present example comprises a semi-cylindricalmember (482). Semi-cylindrical member (482) has a hollow interior formedtherein such that at least a portion of outer sheath (432) may bereceived within semi-cylindrical member (482). Pivot arm (480) alsoincludes a pair of pinholes (485) formed in a proximal portion ofsemi-cylindrical member (482). Outer sheath (432) comprises a pair ofpins (437) extending transversely from an exterior surface of outersheath (432). Pins (437) are pivotably received within pinholes (485) ofsemi-cylindrical member (482) such that pivot arm (480) is pivotablycoupled with outer sheath (432) and such that pivot arm (480) isoperable to rotate about pins (437) of outer sheath (432). Pivot arm(480) is coupled with outer sheath (432) such that semi-cylindricalmember (482) is positioned adjacent to a top surface of outer sheath(432).

As shown in FIGS. 23A and 23B, a translatable sled (490) is disposedwithin the hollow interior of semi-cylindrical member (482) between aninterior surface of semi-cylindrical member (482) and an exterior topsurface of outer sheath (432). Sled (490) is configured to translatelongitudinally within the hollow interior of semi-cylindrical member(482) between a proximal longitudinal position (FIG. 23A) and a distallongitudinal position (FIG. 23B). As will be discussed in more detailbelow, longitudinal translation of sled (490) causes rotation of pivotarm (480) about pins (437) of outer sheath (432). In particular, distallongitudinal translation of a pivot tube (not shown) relative to outersheath (432) causes counter-clockwise rotation of pivot arm (480) aboutpins (437) of outer sheath (432); and proximal longitudinal translationof the pivot tube relative to outer sheath (432) and handle assembly(420) causes clockwise rotation of pivot arm (480) about pins (437) ofouter sheath (432). It should be understood that pivot arm (480) may berotatably biased counter-clockwise to the position shown in FIG. 23B. Byway of example only, such a bias may be provided by a coil spring and/orleaf spring interposed between an interior surface of semi-cylindricalmember (482) and an exterior top surface of outer sheath (432), by oneor more torsion springs positioned about pins (437), and/or by one ormore other features. Various suitable ways in which pivot arm (480) maybe rotatably biased counter-clockwise to the position shown in FIG. 23Bwill be apparent to those of ordinary skill in the art in view of theteachings herein.

Pivot arm (480) further comprises a projection (486) extending distallyfrom a distal end of semi-cylindrical member (482). Clamp arm (444) ispivotably coupled with projection (486) of pivot arm (480) via pin (445)such that, as discussed above, rotation of pivot arm (480) about pins(437) of outer sheath (432) causes nearly or mostly vertical translationof pins (435) within slots (433), thereby causing nearly or mostlyvertical translation of clamp arm (444) relative to ultrasonic blade(460). In particular, counter-clockwise rotation of pivot arm (480)about pins (437) of outer sheath (432) causes clamp arm (444) totranslate nearly or mostly vertically downwardly toward ultrasonic blade(460); and clockwise rotation of pivot arm (480) about pins (437) ofouter sheath (432) causes clamp arm (444) to translate nearly or mostlyvertically upwardly away from ultrasonic blade (460). It shouldtherefore be understood that distal longitudinal translation of sled(490) relative to outer sheath (432) and handle assembly (420) is causescounter-clockwise rotation of pivot arm (480) about pins (437) of outersheath (432), which in turn causes clamp arm (444) to translate nearlyor mostly vertically downwardly toward ultrasonic blade (460); andproximal longitudinal translation of sled (490) relative to outer sheath(432) and handle assembly (420) causes clockwise rotation of pivot arm(480) about pins (437) of outer sheath (432), which in turn causes clamparm (444) to translate nearly or mostly vertically upwardly away fromultrasonic blade (460).

In some versions, sled (490) is coupled with trigger (228) such thatpivotal movement of trigger (228) causes longitudinal movement of sled(490). For instance, in some such versions, trigger (228) may movethrough a first range of motion to retract inner tube (434) proximally,thereby pivoting clamp arm (444) toward ultrasonic blade (460). Sled(490) may remain stationary during this first range of motion of trigger(228). As trigger (228) is moved through a second range of motion, innertube (434) may remain stationary and sled (490) may be drivenproximally, such that pivot arm (480) drives clamp arm (444) downwardlyalong a nearly or mostly vertical linear path toward ultrasonic blade(460). Thus, an instrument (200) with shaft assembly (430) and endeffector (440) may be either in the “seal-only” mode or the“cut-and-seal” mode based on the particular pivotal position of trigger(228) relative to grip (224). Such an instrument may transition betweensuch modes in the same manner as described above with respect toinstrument (200) incorporating shaft assembly (230) and end effector(240) of FIGS. 6-19C, shaft assembly (330) and end effector (340) ofFIG. 20, or shaft assembly (330) and end effector (340) of FIG. 21.

As yet another merely illustrative alternative, some versions mayprovide only pivotal movement of clamp arm (444) about pin (445) inresponse to pivotal movement of trigger (228) relative to pistol grip(224). In some such versions, a separate actuator (e.g., slider,pivoting trigger, button, etc.) may be provided to selectively drivesled (490) between the proximal position (FIG. 23A) and the distalposition (FIG. 23B). Various suitable features that may be used toselectively drive sled (490) will be apparent to those of ordinary skillin the art in view of the teachings herein. Similarly, various suitableways in which an instrument (200) that incorporates shaft assembly (430)and end effector (440) may provide a transition from the “seal-only”mode to the “cut-and-seal” mode will be apparent to those of ordinaryskill in the art in view of the teachings herein.

D. Exemplary Ultrasonic Surgical Instrument with Four-Bar Linkage

FIGS. 24A-24C depict another exemplary alternative shaft assembly (530)and end effector (540) that may be readily incorporated into instrument(200) in place of shaft assembly (230) and end effector (240). Shaftassembly (530) and end effector (540) are configured to operatesubstantially similar to shaft assemblies (230, 330, 430) and endeffectors (240, 340, 440) discussed above except for the differencesdiscussed below. In particular, shaft assembly (530) and end effector(540) are configured to selectively clamp tissue between a clamp arm(544) and an ultrasonic blade (560) of end effector (540) in a“seal-only” operation, in which blade (560) is operable to seal or weldtissue without cutting the tissue; and a “cut-and-seal” operation, inwhich blade (560) is operable to cut tissue and seal or weld tissuesubstantially simultaneously.

Shaft assembly (530) of the present example comprises an outer sheath(532), an inner tube (534), a pivot tube (570), and a pivot arm (580).Inner tube (534) is slidably disposed within outer sheath (532). As withshaft assemblies (230, 330, 430) discussed above, inner tube (534) isoperable to translate longitudinally within outer sheath (532) relativeto outer sheath (532) to selectively pivot clamp arm (544) toward andaway from blade (560). Pivot tube (570) is slidably disposed about outersheath (532) such that pivot tube (570) is operable to translatelongitudinally about outer sheath (532) relative to outer sheath (532).Pivot arm (580) is pivotably coupled with pivot tube (570) via afour-bar linkage (582). While only two bars are shown in four-barlinkage (582), it should be understood that an identical pair of barswould be positioned on the opposite side of pivot tube (570) and pivotarm (580). As with pivot tube (270) discussed above, pivot tube (570) isoperable to translate longitudinally about outer sheath (532) relativeto outer sheath (532) to selectively rotate pivot arm (580) via four-barlinkage (582) to thereby translate clamp arm (544) vertically toward andaway from blade (560) via pins (535) that are disposed within respectiveslots (533) formed within a distal end of inner tube (534). It shouldthere be understood that a combination of rotation and verticaltranslation of clamp arm (544) relative to blade (560) provides both a“seal-only” mode of operation and a “cut-and-seal” mode of operation.

End effector (540) of the present example comprises clamp arm (544) andultrasonic blade (560). Clamp arm (544) includes a primary clamp pad(546) and a secondary clamp pad (548) that are secured to an undersideof clamp arm (544), facing blade (560). Clamp arm (544) is operable toselectively pivot toward and away from blade (560) about a pin (545) toselectively clamp tissue between clamp pads (546, 548) and blade (560).As will be discussed in more detail below, clamp arm (544) is pivotablycoupled with a distal end of pivot arm (580) via pin (545) such thatclamp arm (544) is operable to rotate about the distal end of pivot arm(580). A distal end of inner tube (534) is rotatably and slidablycoupled with a proximal end of clamp arm (544) via pins (535) disposedwithin a respective slots (533) formed in a distal end of inner tube(534) such that longitudinal translation of inner tube (534) causesrotation of clamp arm (544) about the distal end of pivot arm (580)toward and away from ultrasonic blade (560) to thereby clamp tissuebetween clamp pads (546, 548) and ultrasonic blade (560) to cut and/orseal the tissue. In particular, proximal longitudinal translation ofinner tube (534) relative to outer sheath (532) causes clamp arm (544)to rotate about pin (545) at the distal end of pivot arm (580) towardultrasonic blade (560); and distal longitudinal translation of innertube (534) relative to outer sheath (532) causes clamp arm (544) torotate about pin (545) at the distal end of pivot arm (580) away fromultrasonic blade (560).

As mentioned above, the distal end of inner tube (534) is slidablycoupled with the proximal end of clamp arm (544) via pins (535) disposedwithin slots (533) such that clamp arm (544) is operable to transitionbetween an upward vertical and a downward position. As will be discussedin more detail below, rotation of pivot arm (580) causes verticaltranslation of pins (535) relative to slots (533), thereby causing clamparm (544) to clamp tissue between clamp pads (546, 348) and ultrasonicblade (560) to cut and/or seal the tissue. In particular,counter-clockwise rotation of pivot arm (580) about outer sheath (532)causes clamp arm (544) to translate vertically downwardly towardultrasonic blade (560); and clockwise rotation of pivot arm (580) aboutouter sheath (532) causes clamp arm (544) to translate verticallyupwardly away from ultrasonic blade (560). As shown in FIGS. 24A-24C, asinner tube (534) is translated longitudinally proximally relative toouter sheath (532), clamp arm (544) is pivoted into the “seal-only”position as shown in FIG. 24B. As pivot tube (570) is translatedlongitudinally proximally relative to outer sheath (532), four-barlinkage (582) translates pivot arm (580) downwardly toward blade (560)at the distal end of shaft assembly (530) to thereby verticallytranslate clamp arm (544) toward blade (560) within slot (533) into the“cut-and-seal” position. Pivot arm (580) is constrained from movinglongitudinally proximally or distally by one or more features (notshown) in outer sheath (532).

In some versions, pivot tube (570) is coupled with trigger (228) suchthat pivotal movement of trigger (228) causes longitudinal movement ofpivot tube (570). For instance, in some such versions, trigger (228) maymove through a first range of motion to retract inner tube (534)proximally, thereby pivoting clamp arm (544) toward ultrasonic blade(560). Pivot tube (570) may remain stationary during this first range ofmotion of trigger (228). As trigger (228) is moved through a secondrange of motion, inner tube (534) may remain stationary and pivot tube(570) may be driven proximally, such that pivot arm (580) drives clamparm (544) downwardly along a vertical linear path toward ultrasonicblade (560). Thus, an instrument (200) with shaft assembly (530) and endeffector (540) may be either in the “seal-only” mode or the“cut-and-seal” mode based on the particular pivotal position of trigger(228) relative to grip (224). Such an instrument may transition betweensuch modes in the same manner as described above with respect toinstrument (200) incorporating shaft assembly (230) and end effector(240) of FIGS. 6-19C, shaft assembly (330) and end effector (340) ofFIG. 20, or shaft assembly (330) and end effector (340) of FIG. 21.

As yet another merely illustrative alternative, some versions mayprovide only pivotal movement of clamp arm (544) about pin (545) inresponse to pivotal movement of trigger (228) relative to pistol grip(224). In some such versions, a separate actuator (e.g., slider,pivoting trigger, button, etc.) may be provided to selectively drivepivot tube (570) between the distal position (FIGS. 24A-24B) and theproximal position (FIG. 24B). Various suitable features that may be usedto selectively drive pivot tube (570) will be apparent to those ofordinary skill in the art in view of the teachings herein. Similarly,various suitable ways in which an instrument (200) that incorporatesshaft assembly (530) and end effector (540) may provide a transitionfrom the “seal-only” mode to the “cut-and-seal” mode will be apparent tothose of ordinary skill in the art in view of the teachings herein.

E. Exemplary Handle Assembly with Additional Mode Selection Switch

FIG. 25 depicts an exemplary alternative handle assembly (620) that maybe readily incorporated into instrument (200) for use with any of theshaft assemblies (230, 330, 430, 530) and/or end effectors (240, 340,440, 540) discussed above. Handle assembly (620) of this example isconfigured to operate substantially similar to handle assembly (220)discussed above except for the differences discussed below. Handleassembly (620) of the present example, however, comprises a switchassembly (630). Switch assembly (630) is configured to vertically ornearly vertically translate a clamp arm (not shown) between a“seal-only” operation and a “cut-and-seal” operation in addition to orin lieu of translation and rotation caused by trigger (228). Switchassembly (630) comprises a slider (632) that is longitudinallytranslatable between a proximal longitudinal position and a distallongitudinal position. Longitudinal translation of slider (632) betweenthe proximal longitudinal position and the distal longitudinal positioncauses movement of the clamp arm between the “seal-only” operation andthe “cut-and-seal” operation. For example, proximal longitudinaltranslation of slider (632) may move the clamp arm downwardly from the“seal-only” operation to the “cut-and-seal” operation; and distallongitudinal translation of switch assembly (630) may translate theclamp arm upwardly from the “cut-and-seal” operation to the “seal-only”operation. Various suitable components and features that may be used toprovide translational and rotational movement of a clamp arm downwardlyin response to longitudinal movement of slider (632) will be apparent tothose of ordinary skill in the art in view of the teachings herein.

As one merely illustrative variation, switch assembly (630) may beconfigured such that slider (632) moves along a vertical path. Forinstance, switch assembly (630) may provide upward movement of the clamparm away from the ultrasonic blade in response to upward movement ofslider (632); and downward movement of the clamp arm away from theultrasonic blade in response to downward movement of slider (632).Alternatively, switch assembly (630) may provide upward movement of theclamp arm away from the ultrasonic blade in response to downwardmovement of slider (632); and downward movement of the clamp arm awayfrom the ultrasonic blade in response to upward movement of slider(632). As another merely illustrative example, handle assembly (620) maycomprise a motor that is operable to transition the clamp arm between a“seal-only” operation and a “cut-and-seal” operation in addition to orin lieu of vertical translation caused by a trigger (228) and/or switchassembly (630). Such a motor may be actuated by, for example, one ofbuttons (226) or some other user input feature. Still other suitablefeatures that may be provided to transition the clamp arm between a“seal-only” operation and a “cut-and-seal” operation will be apparent tothose of ordinary skill in the art in view of the teachings herein.

As yet another merely illustrative example, handle assembly (620) maycomprise a switch assembly (640) that is operable to selectively limitproximal longitudinal translation of an inner tube (634) as shown inFIGS. 26A-26D. Inner tube (634) is configured to operate substantiallysimilar to inner tubes (134, 234, 334, 434, 534) described above exceptfor the differences discussed below. In particular, inner tube (634) isoperable to translate longitudinally within an outer sheath (632)relative to outer sheath (632) to selectively pivot a clamp arm (notshown) toward and away from an ultrasonic blade (not shown). Inparticular, proximal longitudinal translation of inner tube (634)relative to outer sheath (632) causes pivoting of the clamp arm towardthe blade and distal longitudinal translation of inner tube (634)relative to outer sheath (632) causes pivoting of the clamp arm awayfrom the blade. Thus, it should be appreciated that by limiting proximallongitudinal translation of inner tube (634), switch assembly (640) willlimit pivoting of the clamp arm toward the blade.

FIGS. 26A-26D show the operation of switch assembly (640). Switchassembly (640) comprises a switch (642) that is slidably disposed withina slot (644) formed in a top surface of handle assembly (620). As willbe described in more detail below, switch (642) is operable to slidewithin slot (644) between a distal position (FIGS. 26A and 26B) and aproximal position (FIGS. 26C and 26D). FIG. 26A shows switch (642) inthe distal position within slot (644). As shown in FIG. 26B, as innertube (634) is translated longitudinally proximally relative to outersheath (632) so as to pivot the clamp arm toward the blade into apartially closed, or “seal-only,” position, an integral flange (635) atthe proximal end of inner tube (634) engages a distal arm (646) ofswitch (642) to thereby prevent further proximal longitudinaltranslation of inner tube (634). This prevents further pivoting of theclamp arm toward the blade. As shown in FIG. 26C, switch (642) may beslid proximally within slot (644) to the proximal position. With switch(642) in the proximal position, distal arm (646) is positioned to permitfurther proximal translation of flange (635). Inner tube (634) may thusbe further translated longitudinally proximally relative to outer sheath(632) as shown in FIG. 26D so as to further pivot the clamp arm towardthe blade into the completely closed, or “cut-and-seal,” position. Itshould be appreciated that switch (642) may be slid within slot (644)into any desired position between the distal position and the proximalposition so as to limit pivoting of the clamp arm to any desiredposition between the partially closed position and the completely closedposition.

In some variations of the example shown in FIGS. 26A-26D, switch (642)is used in an instrument that has a pivot tube such as any of thevarious pivot tubes (270, 370, 470, 570) described herein. For instance,switch (642) may be positioned and configured such that distal arm (646)selectively engages an integral proximal flange (e.g., flange (274)) ofpivot tube (270, 370, 470, 570) to thereby selectively restrict proximalmovement of pivot tube (270, 370, 470, 570). When switch (642) is in adistal position, distal arm (646) may restrict proximal motion of pivottube (270, 370, 470, 570) such that the instrument is only operable in a“seal-only” mode. When switch (642) is in a proximal position, distalarm (646) may prevent pivot tube (270, 370, 470, 570) to move fullyproximally, thereby enabling operation in a “cut-and-seal” mode. Othersuitable ways in which switch (642) may be incorporated into aninstrument will be apparent to those of ordinary skill in the art inview of the teachings herein.

F. Exemplary Ultrasonic Surgical Instrument with Segmented Clamp Arm

FIGS. 27A-28B depict an exemplary alternative shaft assembly (730) andend effector (740) that may be readily incorporated into instrument(100, 200) in place of shaft assembly (130, 230) and end effector (140,240). End effector (740) of this example includes a first clamp arm(742), a second clamp arm (746), and an ultrasonic blade (760). Firstclamp arm (742) has a first pair of legs (741). Legs (741) straddle aproximal end of ultrasonic blade (760), such that one leg (741) ispositioned at one lateral side of ultrasonic blade (760) while the otherleg (741) is positioned at the other lateral side of ultrasonic blade(760). Each leg (741) also has a sloped face (743). Second clamp arm(742) also has a second pair of legs (744). Legs (744) also straddle aproximal end of ultrasonic blade (760), such that one leg (744) ispositioned at one lateral side of ultrasonic blade (760) while the otherleg (744) is positioned at the other lateral side of ultrasonic blade(760). Clamp arm (746) is positioned laterally inwardly from clamp arm(742); and legs (744) are positioned laterally inwardly from legs (741).Ultrasonic blade (760) is substantially similar to ultrasonic blade(160, 260) mentioned above.

Similar to clamp arm (144, 244), first clamp arm (742) and second clamparm (746) each include a clamp pad (780, 781) facing toward ultrasonicblade (760). Additionally, first clamp arm (742) and second clamp arm(746) may are coupled with trigger (128) such that first clamp arm (742)and second clamp arm (746) are pivotable toward ultrasonic blade (760)in response to pivoting of trigger (128) toward pistol grip (124); andsuch that first clamp arm (742) and second clamp arm (746) are pivotableaway from ultrasonic blade (760) in response to pivoting of trigger(128) away from pistol grip (124). As will be described in greaterdetail below, first clamp arm (742) and second clamp arm (744) areconfigured to pivot together toward blade (760) to a first closedposition, defining a gap distance (d) as shown in FIGS. 27B and 28A.Additionally, second clamp arm (744) is configured to pivot furthertoward blade (760) to a second closed position while first clamp arm(742) remains in the first closed position, as shown in FIGS. 27C and28B.

Shaft assembly (730) of the present example comprises an outer sheath(732) having a resilient distal end (737), an inner tube (734) having adistally projecting stop (736), and a waveguide (702) disposed withininner tube (734). Shaft assembly (730) is substantially similar to shaftassembly (130) described above, except for the differences discussedbelow. Therefore, waveguide (702) may communicate ultrasonic vibrationsfrom transducer assembly (112) to ultrasonic blade (760).

While inner tube (134) is slidably disposed within outer sheath (132) ofshaft assembly (130), outer sheath (732) of the current example isslidable relative to inner tube (734) of shaft assembly (730).Therefore, outer sheath (732) is operable to translate longitudinallyrelative to inner tube (734) to selectively pivot first clamp arm (742)and second clamp arm (746) while inner tube (734) remains stationary. Ofcourse, inner tube (734) may alternatively be configured to translatelongitudinally relative to outer sheath (732) to selectively pivot firstclamp arm (742) and second clamp arm (746).

As shown in FIGS. 28A-28B, first clamp arm (742) is fork shaped todefine a recess (747) that receives second clamp arm (746). Second clamparm (746) is free to move along a vertical plane within recess (747).Both first clamp arm (742) and second clamp arm (746) are pivotallycoupled to inner tube (734) via pin (745). While first clamp arm (742)is currently shown with a fork shape, it should be noted that this ismerely optional, as first clamp arm (742) could be a single arm directlyadjacent to second clamp arm (746). As another merely illustrativeexample, first clamp arm (742) may be U-shaped, with the bend of the “U”being distal to the distal end of second clamp arm (746). Other suitableconfigurations that may be used to form first clamp arm (742) will beapparent to one having ordinary skill in the art in view of theteachings herein.

Each first leg (741) and each second leg (744) extend from pin (745)toward and within a respective slot (733) defined by resilient distalend (737) of outer sheath (732). Each second leg (744) extends pastsloped face (743) of the corresponding first leg (741). Slot (733)includes a proximal face (738) and a distal face (739). Distaltranslation of outer sheath (732) may cause proximal face (738) of slot(733) to contact first leg (741) and second leg (744) simultaneously,thereby rotating first clamp arm (742) and second clamp arm (746) awayfrom ultrasonic blade (760).

As seen in FIGS. 27A-27B, proximal translation of outer sheath (732) maycause distal face (739) of slot (733) to contact first leg (741) andsecond leg (744), thereby rotating first clamp arm (742) and secondclamp arm (746) simultaneously toward ultrasonic blade (760) to a firstclosed position shown in FIGS. 27B and 28A. With clamp arms (742, 746)positioned as shown in FIG. 27B and FIG. 28A, distal face (739) of slot(733) forces first leg (741) in contact with stop (736). Stop (736) isconfigured to prevent first leg (741) from further pivotal movement.Stop (736) is nevertheless dimensioned to not interfere with rotation ofsecond leg (744). With clamp arms (742, 746) positioned as shown in FIG.27B and FIG. 28A, second leg (744) is aligned with first leg (741), suchthat clamp pads (780, 781) are coplanar with each other, and such thatboth clamp pads (780, 781) are oriented parallel to ultrasonic blade(760). This positioning of clamp arms (742, 746) provides gap distance(d) between ultrasonic blade (760) and clamp pads (780, 781). By way ofexample only, gap distance (d) may be dimensioned around 0.010 inches.Alternatively, any other suitable gap distance (d) may be provided.

Gap distance (d), similar to gap (G) described above, is configured tominimize a clamping pressure applied to tissue captured between clamparms (742, 746) and blade (760) such that blade (760) is operable toseal or weld the tissue, but not cut the tissue in this position. Itshould be appreciated that handle assembly (120), shaft assembly (730),and/or end effector (740) may include features that are configured toprovide tactile and/or auditory feedback to the operator to signal thatclamp arms (742, 746) have reached this “seal-only” position. By way ofexample only, such feedback features may comprise detents, etc.Additionally or alternatively, handle assembly (120) may include alockout that holds trigger (128) at the pivotal position associated withgap distance (d) between achieved between ultrasonic blade (760) andclamp pads (780, 781). The associated lockout with trigger (128) may beremoved by an additional user input or may be automatically controlledby several mechanisms or means, such as a retractable pin or solenoidselectively allowing further proximal movement of outer sheath (732).

As seen in FIG. 27C, outer sheath (732) may translate further in theproximal direction. During such proximal movement, distal face (739) ofslot (733) may contact sloped face (743) of first leg (741). Becausefirst leg (741) is prevented from further rotation due to contact withstop (736) of inner tube (734), resilient distal end (737) of outersheath (732) deforms downwardly due to camming contact with sloped face(743) of first leg (741). Distal face (739) still remains in contactwith second leg (744) of second clamp arm (746). Therefore, second clamparm (746) is pivoted further toward ultrasonic blade (760) as shown inFIGS. 27C and 28B. At this position, second clamp arm (746) isconfigured to further compress tissue, increasing clamping pressureapplied to tissue captured between clamp arm (746) and blade (760) suchthat blade (760) is operable to cut and seal tissue in this position.Thus, as outer sheath (732) translates proximally through a first rangeof motion (from the position shown in FIG. 27A to the position shown inFIG. 27B), end effector (740) transitions to a “seal only” mode ofoperation; and as outer sheath (732) translates proximally through asecond range of motion (from the position shown in FIG. 27B to theposition shown in FIG. 27C), end effector (740) transitions to a “sealand cut” mode of operation.

When the operator releases trigger (128), outer sheath (732) maytranslate distally. During such distal motion of outer sheath (732),resilient distal end (737) may return to its original shape, as shown inFIGS. 27A-27B, once distal face (739) is no longer in contact withsloped face (743) of first leg (741). Therefore, an operator maymanipulate shaft assembly (730) multiple times between positions shownin FIGS. 27A-27C without affecting the structural integrity of shaftassembly (730). It should also be understood that proximal face (738)may bear against legs (741, 744) during distal motion of outer sheath(732), thereby driving clamp arms (742, 746) back to the open position.

G. Exemplary Ultrasonic Surgical Instrument with Slidable Clamp Arm Stop

FIGS. 29A-29C depict an exemplary alternative shaft assembly (830) andend effector (840) that may be readily incorporated into instrument(100, 200) in place of shaft assembly (130, 230) and end effector (140,240). End effector (840) of this example includes a pivotable clamp arm(844) and an ultrasonic blade (860). Ultrasonic blade (860) issubstantially similar to ultrasonic blade (160, 260) mentioned above.Similar to clamp arm (144, 244), clamp arm (844) includes a clamp pad(880) facing towards ultrasonic blade (860). Additionally, clamp arm(844) may be coupled with trigger (128) such that clamp arm (844) ispivotable toward ultrasonic blade (860) in response to pivoting oftrigger (128) toward pistol grip (124); and such that clamp arm (844) ispivotable away from ultrasonic blade (860) in response to pivoting oftrigger (128) away from pistol grip (124).

As will be described in greater detail below, clamp arm (844) isconfigured to pivot toward blade (860) to a first closed position,defining a gap distance (d) as shown in FIG. 29C. Additionally, clamparm (844) is configured to pivot further toward blade (860) to a secondclosed position as shown in FIG. 29B.

Shaft assembly (830) includes an outer sheath (832), an inner tube (834)disposed within outer sheath (832), a waveguide (802) disposed withininner tube (834), a seal (804), and a moveable clamp arm stop (839)having a distal projection (837) with clamp pad material (838). Similarto shaft assembly (730), Outer sheath (832) of the current example isslidable relative to inner tube (834) of shaft assembly (830).

The distal end of inner tube (834) defines a slot (843). Clamp arm (844)further includes a leg (846) that is pivotally coupled to slot (843) ofinner tube (834) via pin (845). Pin (845) is free to verticallytranslate within slot (843). A distal end of outer sheath (832) alsodefines a slot (833). Slot (833) of outer sheath (832) is rotatablycoupled with leg (846) of clamp arm (844) below ultrasonic blade (860)via a pin (835) such that longitudinal translation of outer sheath (832)relative to inner tube (834) causes rotation of clamp arm (844) aboutpin (845) toward and away from ultrasonic blade (860) to thereby clamptissue between clamp arm (844) and ultrasonic blade (860) to cut and/orseal the tissue. In particular, proximal longitudinal translation ofouter sheath (832) relative to inner tube (834) and handle assembly(120) causes clamp arm (844) to move toward ultrasonic blade (860); anddistal longitudinal translation of outer sheath (832) relative to innertube (834) and handle assembly (120) causes clamp arm (844) to move awayfrom ultrasonic blade (860).

Moveable clamp arm stop (839) is longitudinally slidable relative toouter sheath (832), inner tube (834), and waveguide (802). Distalprojection (837) of moveable clamp arm stop (839) extends through outersheath (832) and inner tube (834). As shown in FIGS. 29A-29B, clamp padmaterial (838) of moveable clamp arm stop (839) is configured to fitwithin a recess (806) defined by waveguide (802) when moveable clamp armstop (839) is in a first position. Moveable clamp arm stop (839) mayslide in the distal direction out of recess (806) to a second positionas shown in FIG. 29C. When moveable clamp arm stop (839) slides out ofrecess (806), clamp pad material (838) makes contact with the outerdiameter of waveguide (802). As will be described in greater detailbelow, moveable clamp arm stop (839) is configured to prevent clamp arm(844) from fully closing relative to blade (860).

FIG. 29A shows clamp arm (844) in an open position. When clamp arm (844)is in an open position, outer sheath (832) is in a distal position.Additionally, pin (845) is in a raised position within slot (843). Whenmovable stop (839) is in the first position, as shown in FIG. 29B,proximal translation of outer sheath (832) relative to inner tube (834)rotates clamp arm (844) about pin (845) unobstructed so that clamp arm(844) is in a completely closed position. In other words, stop (839)does not interfere with pivotal movement of clamp arm (844) when stop(839) is in the first position. Since pin (845) is free to verticallytranslate within slot (843), rotation of clamp arm (844) forces pin(845) in the downward direction to the bottom of slot (843). Clamp pad(880) is thus positioned adjacent to blade (860) without a gap betweenclamp pad (880) and blade (860). At this position, clamp arm (844) isconfigured to grasp tissue with a clamping pressure applied to tissuecaptured between clamp arm (844) and blade (860) such that end effector(840) is operable to cut and seal tissue in this position.

As mentioned above, moveable clamp arm stop (839) may translate from afirst longitudinal position, where clamp pad material (838) extendswithin recess (806), to a second longitudinal position, where clamp padmaterial (838) contacts the outer diameter of waveguide (802). FIG. 29Cshows stop (839) in the second position. As shown in FIG. 29C, movablestop (839) is configured to limit the range of rotation of clamp arm(844) via contact between movable clamp arm stop (839) and nub (848) ofclamp arm (844) when clamp arm stop (839) is in the second longitudinalposition. Movable clamp arm stop (839) is positioned such that contactwith nub (848) occurs when pin (845) is in between the top and bottom ofslot (843). Because pin (845) in located between the top and bottom ofslot (843), clamp arm (844) and blade (860) define gap distance (d).

Gap distance (d), similar to gap (G) described above, is configured tominimize a clamping pressure applied to tissue captured between clamparm (844) and blade (860) such that blade (860) is operable to seal orweld the tissue, but not cut the tissue in this position. Therefore,depending on the location of moveable clamp arm stop (839), closing ofclamp arm (844) may grasp tissue such that blade (860) is operable toonly seal tissue or cut and seal tissue. It should be understood thatany suitable user input feature may be used to drive stop (839) betweenthe first and second positions. Various suitable features that may beused to drive stop (839) between the first and second positions will beapparent to those of ordinary skill in the art in view of the teachingsherein.

H. Exemplary Ultrasonic Surgical Instrument with Rotatable Clamp ArmStop

FIGS. 30A-31B depict another exemplary alternative shaft assembly (930)and end effector (940) that may be readily incorporated into instrument(100, 200) in place of shaft assembly (130, 230) and end effector (140,240). End effector (940) of this example includes a pivotable clamp arm(944) and an ultrasonic blade (960). Ultrasonic blade (960) issubstantially similar to ultrasonic blade (160, 260) mentioned above.Similar to clamp arm (144, 244), clamp arm (944) includes a clamp pad(980) facing toward ultrasonic blade (960). Additionally, clamp arm(944) may be coupled with trigger (128) such that clamp arm (944) ispivotable toward ultrasonic blade (960) in response to pivoting oftrigger (128) toward pistol grip (124); and such that clamp arm (944) ispivotable away from ultrasonic blade (960) in response to pivoting oftrigger (128) away from pistol grip (124).

As will be described in greater detail below, clamp arm (944) isconfigured to pivot toward blade (960) to a first closed position,defining a gap distance (d) as shown in FIG. 30C. Additionally, clamparm (944) is configured to pivot further toward blade (960) to a secondclosed position as shown in FIG. 30B.

Shaft assembly (930) includes an outer sheath (892), an inner tube (934)disposed within outer sheath (932), a waveguide (902) disposed withininner tube (934), a seal (804), and a clamp arm stop (906) fixed towaveguide (902). In particular, clamp arm stop (906) is in the form of aprojection extending laterally and unitarily from waveguide (902).Similar to shaft assembly (730, 830), outer sheath (932) of the currentexample is slidable relative to inner tube (934) of shaft assembly(930). Outer sheath (932) also includes a lateral opening (936) that issized to receive a nub (948) of clamp arm (944) when clamp arm (944)rotates to a closed position.

The distal end of inner tube (934) defines a slot (943). A leg (946) ofclamp arm (944) is pivotally coupled to slot (943) of inner tube (934)via pin (945). Pin (945) is free to vertically translate within slot(943). A distal end of outer sheath (932) defines a slot (933). Slot(933) of outer sheath (932) is rotatably coupled with leg (946) of clamparm (944) below ultrasonic blade (960) via a pin (935) such thatlongitudinal translation of outer sheath (932) relative to inner tube(934) causes rotation of clamp arm (944) about pin (945) toward and awayfrom ultrasonic blade (960) to thereby clamp tissue between clamp arm(944) and ultrasonic blade (960) to cut and/or seal the tissue. Inparticular, proximal longitudinal translation of outer sheath (932)relative to inner tube (934) and handle assembly (120) causes clamp arm(944) to move toward ultrasonic blade (960); and distal longitudinaltranslation of outer sheath (932) relative to inner tube (934) andhandle assembly (120) causes clamp arm (944) to move away fromultrasonic blade (960).

Clamp arm stop (906) is fixed along waveguide (902) such that clamp armstop (960) is longitudinally aligned with opening (936). As shown inFIGS. 31A-31B, waveguide (902) may rotate about its own longitudinalaxis. Rotation of waveguide (902) allows clamp arm stop (906) to bepositioned adjacent to opening (936), as shown in FIGS. 30C and 31B, oraway from lateral opening (936), as shown in FIGS. 30A and 31A. As willbe described in greater detail below, moveable clamp arm stop (906) isconfigured to prevent clamp arm (944) from fully closing relative toblade (960) based on the angular position of waveguide (902).

FIG. 30A shows clamp arm (944) in an open position. When clamp arm (944)is in an open position, outer sheath (932) is in a distal position.Additionally, pin (945) is in a raised position within slot (943). Whenclamp arm stop (906) is in a position facing away from opening (936), asshown in FIGS. 30B and 31A, proximal translation of outer sheath (932)relative to inner tube (934) rotates clamp arm (944) about pin (945)unobstructed so that clamp arm (944) is in a completely closed position.In other words, stop (906) does not interfere with pivotal movement ofclamp arm (944) when stop (906) is in the first position. Since pin(945) is free to vertically translate within slot (943), rotation ofclamp arm (944) forces pin (945) in the downward direction to the bottomof slot (943). Clamp pad (980) is thus positioned adjacent to blade(960) without a gap between clamp pad (980) and blade (960). At thisposition, clamp arm (944) is configured to grasp tissue with a clampingpressure applied to tissue captured between clamp arm (944) and blade(960) such that end effector (940) is operable to cut and seal tissue inthis position.

As mentioned above, waveguide (902) may rotate about the longitudinalaxis of waveguide (902) between a first angular position (FIGS. 30A-30B)and a second angular position (FIG. 30C). With waveguide (902) in thefirst angular position, stop (906) faces away from opening (936). Withwaveguide (902) in the second angular position, stop (906) faces towardopening (936). As shown in FIGS. 30C and 31B, stop (906) is configuredto limit the range of rotation of clamp arm (944) via contact betweenclamp arm stop (906) and nub (948) of clamp arm (944) when waveguide(902) is in the second angular position. Clamp arm stop (906) ispositioned such that contact with nub (948) occurs when pin (945) is inbetween the top and bottom of slot (943). Because pin (945) is locatedbetween the top and bottom of slot (943), clamp pad (980) and blade(960) define gap distance (d).

Gap distance (d), similar to gap (G) described above, is configured tominimize a clamping pressure applied to tissue captured between clamparm (944) and blade (960) such that blade (960) is operable to seal orweld the tissue, but not cut the tissue in this position. Therefore,depending on the location of clamp arm stop (906), closing of clamp arm(944) may grasp tissue such that blade (960) is operable to only sealtissue or cut and seal tissue. It should be understood that any suitableuser input feature may be used to drive waveguide (902) between thefirst angular position and the second angular position. Various suitablefeatures that may be used to drive waveguide (902) between the firstangular position and the second angular position will be apparent tothose of ordinary skill in the art in view of the teachings herein.

I. Exemplary Ultrasonic Surgical Instrument with Slidable InternalTissue Gap Stop

FIGS. 32A-34 depict another exemplary alternative shaft assembly (1030)and end effector (1040) that may be readily incorporated into instrument(100, 200) in place of shaft assembly (130, 230) and end effector (140,240). End effector (1040) includes a pivotable clamp arm (1044) and anultrasonic blade (1060). Ultrasonic blade (1060) is substantiallysimilar to ultrasonic blade (160, 260) mentioned above. Similar to clamparm (144, 244), clamp arm (1044) may include a clamp pad (1080) facingtoward ultrasonic blade (1060). Additionally, clamp arm (1044) may becoupled with trigger (128) such that clamp arm (1044) is pivotabletoward ultrasonic blade (1060) in response to pivoting of trigger (128)toward pistol grip (124); and such that clamp arm (1044) is pivotableaway from ultrasonic blade (1060) in response to pivoting of trigger(128) away from pistol grip (124).

As will be described in greater detail below, clamp arm (1044) isconfigured to pivot toward blade (1060) to a first closed position,defining a gap distance (d) as shown in FIG. 32C. Additionally, clamparm (1044) is configured to pivot further toward blade (1060) to asecond closed position as shown in FIG. 32B.

Shaft assembly (1030) includes an outer sheath (1032), an inner tube(1034) disposed within outer sheath (1032), a waveguide (1002) disposedwithin inner tube (1034), a seal (1004), and a moveable clamp arm stop(1038) connected to rods (1039) extending through seal (1004). Similarto shaft assembly (730, 830, 930), Outer sheath (1032) of the currentexample is slidable relative to inner tube (1034) of shaft assembly(1030). Outer sheath (1032) also includes a lateral opening (1036) thatis sized to receive a nub (1048) of clamp arm (1044) when clamp arm(1044) rotates to a closed position.

The distal end of inner tube (1034) defines a slot (1043). A leg (1046)of clamp arm (1044) is pivotally coupled to slot (1043) of inner tube(1034) via pin (1045). Pin (1045) is free to vertically translate withinslot (1043). A distal end of outer sheath (1032) defines a slot (1033).Slot (1033) of outer sheath (1032) is rotatably coupled with leg (1046)of clamp arm (1044) below ultrasonic blade (1060) via a pin (1035) suchthat longitudinal translation of outer sheath (1032) relative to innertube (1034) causes rotation of clamp arm (1044) about pin (1045) towardand away from ultrasonic blade (1060) to thereby clamp tissue betweenclamp arm (1044) and ultrasonic blade (1060) to cut and/or seal thetissue. In particular, proximal longitudinal translation of outer sheath(1032) relative to inner tube (1034) and handle assembly (120) causesclamp arm (1044) to move toward ultrasonic blade (1060); and distallongitudinal translation of outer sheath (1032) relative to inner tube(1034) and handle assembly (120) causes clamp arm (1044) to move awayfrom ultrasonic blade (1060).

As best seen in FIG. 33, clamp arm stop (1038) is in the form of a rigidannular member that is coaxially disposed around waveguide (1002). Asbest seen in FIG. 34, rods (1039) extend through seal (1004).Additionally, rods (1039) are slidable relative to seal (1004).Therefore, clamp arm stop (1038) is slidable relative to outer sheath(1032), inner tube (1034), and waveguide (1002) via rods (1039). As seenin FIGS. 32A-32C, clamp arm stop (1038) may slide between a firstlongitudinal position (FIGS. 32A-32B) and a second longitudinal position(FIG. 32C). In the first longitudinal position, clamp arm stop (1038) islocated proximally in relation to lateral opening (1036). In the secondlongitudinal position, clamp arm stop (1038) is located adjacent tolateral opening (1036). As will be described in greater detail below,clamp arm stop (1038) is configured to prevent clamp arm (1044) fromfully closing relative to blade (1060) when clamp arm stop (1038) is inthe second longitudinal position.

FIG. 32A shows clamp arm (1044) in an open position. When clamp arm(1044) is in an open position, outer sheath (1032) is in a distalposition. Additionally, pin (1045) is in a raised position within slot(1043). When movable stop (1037) is in the first longitudinal position,as shown in FIG. 32B, proximal translation of outer sheath (1032)rotates clamp arm (1044) about pin (1045) unobstructed so that clamp arm(1044) is in a completely closed position. In other words, stop (1038)does not interfere with pivotal movement of clamp arm (1044) when stop(1038) is in the first position. Since pin (1045) is free to verticallytranslate within slot (1043), rotation of clamp arm (1044) forces pin(1045) in the downward direction to the bottom of slot (1043). Clamp pad(1080) is thus positioned adjacent to blade (1060) without a gap. Atthis position, clamp arm (1044) is configured to grasp tissue with aclamping pressure applied to tissue captured between clamp arm (1044)and blade (1060) such that end effector (1040) is operable to cut andseal tissue in this position.

As mentioned above, clamp arm stop (1038) may translate from a firstlongitudinal position, proximal to opening (1036), to a secondlongitudinal position, adjacent to opening (1036). As shown in FIG. 32C,clamp arm stop (1038) is configured to limit the range of rotation ofclamp arm (1044) via contact between clamp arm stop (1038) and nub(1048) of clamp arm (1044) when stop (1038) is in the secondlongitudinal position. Clamp arm stop (1038) is positioned such thatcontact with nub (1048) occurs when pin (1045) is in between the top andbottom of slot (1043). Because pin (1045) in located between the top andbottom of slot (1043), clamp arm (1044) and blade (1060) define gapdistance (d).

Gap distance (d), similar to gap (G) described above, is configured tominimize a clamping pressure applied to tissue captured between clamparm (1044) and blade (1060) such that blade (1060) is operable to sealor weld the tissue, but not cut the tissue in this position. Therefore,depending on the location of moveable clamp arm stop (1038), closing ofclamp arm (1044) may grasp tissue such that blade (1060) is operable toonly seal tissue or cut and seal tissue. It should be understood thatany suitable user input feature may be used to drive stop (1038) betweenthe first longitudinal position and the second longitudinal position.Various suitable features that may be used to drive stop (1038) betweenthe first longitudinal position and the second longitudinal positionwill be apparent to those of ordinary skill in the art in view of theteachings herein.

IV. EXEMPLARY COMBINATIONS

The following examples relate to various non-exhaustive ways in whichthe teachings herein may be combined or applied. It should be understoodthat the following examples are not intended to restrict the coverage ofany claims that may be presented at any time in this application or insubsequent filings of this application. No disclaimer is intended. Thefollowing examples are being provided for nothing more than merelyillustrative purposes. It is contemplated that the various teachingsherein may be arranged and applied in numerous other ways. It is alsocontemplated that some variations may omit certain features referred toin the below examples. Therefore, none of the aspects or featuresreferred to below should be deemed critical unless otherwise explicitlyindicated as such at a later date by the inventors or by a successor ininterest to the inventors. If any claims are presented in thisapplication or in subsequent filings related to this application thatinclude additional features beyond those referred to below, thoseadditional features shall not be presumed to have been added for anyreason relating to patentability.

Example 1

An apparatus for operating on tissue, the apparatus comprising: (a) abody; (b) a shaft assembly, wherein the shaft assembly extends distallyfrom the body, wherein the shaft assembly comprises an acousticwaveguide, wherein the waveguide is configured to acoustically couplewith an ultrasonic transducer; (c) an end effector, wherein the endeffector comprises: (i) an ultrasonic blade in acoustic communicationwith the waveguide, and (ii) a clamp arm, wherein the clamp arm isconfigured to pivot toward and away from the ultrasonic blade, whereinthe clamp arm is configured to pivot and stop at a first closed positionassociated with a first mode of operation, wherein the clamp arm isconfigured to pivot and stop at a second closed position associated witha second mode of operation.

Example 2

The apparatus of Example 1, wherein the clamp arm is configured to pivottoward and away from the ultrasonic blade about a first pivot point,wherein the clamp arm is configured to pivot from an open position tothe first closed position, wherein the clamp arm is further configuredto pivot about a second pivot point toward and away from the ultrasonicblade from the first closed position to the second closed position,wherein the second pivot point is proximal to the first pivot point,wherein the clamp arm is parallel to the ultrasonic blade at the firstclosed position.

Example 3

The apparatus of Example 2, wherein the clamp arm is parallel to theultrasonic blade at the second closed position.

Example 4

The apparatus of any one or more of Examples 2 through 3, wherein theclamp arm is oriented at an oblique angle relative to the ultrasonicblade at the open position.

Example 5

The apparatus of any one or more of Examples 2 through 5, wherein theshaft assembly further comprises: (i) an outer sheath, and (ii) a firsttranslatable member, wherein the first translatable member is configuredto translate longitudinally relative to the outer sheath, wherein theclamp arm is configured to pivot toward and away from the ultrasonicblade along the angular path from the open position to the first closedposition in response to longitudinal translation of the firsttranslatable member relative to the outer sheath.

Example 6

The apparatus of Example 5, wherein the first translatable membercomprises an inner tube, wherein the inner tube is slidably disposedwithin the outer sheath.

Example 7

The apparatus of any one or more of Examples 5 through 6, wherein theshaft assembly further comprises a pivot arm, wherein the pivot arm ispivotably coupled with the outer sheath at the second pivot point.

Example 8

The apparatus of Example 7, further comprising a second translatablemember, wherein the second translatable member is configured totranslate longitudinally relative to the outer sheath, wherein the pivotarm is configured to pivot relative to the outer sheath in response totranslation of the second translatable member relative to the outersheath.

Example 9

The apparatus of Example 8, wherein the second translatable member isdisposed about the outer sheath.

Example 10

The apparatus of any one or more of Examples 8 through 9, wherein thesecond translatable comprises a pin, wherein the pivot arm comprises aslot, wherein the pin is disposed in the slot, wherein the pin and theslot are configured to cooperate to provide the pivotal movement of thepivot arm relative to the outer sheath in response to translation of thesecond translatable member relative to the outer sheath.

Example 11

The apparatus of any one or more of Examples 7 through 10, wherein theclamp arm comprises a first pivotal coupling and a second pivotalcoupling, wherein the clamp arm is coupled with the first translatablemember via the first pivotal coupling, wherein the clamp arm is coupledwith the pivot arm via the second pivotal coupling.

Example 12

The apparatus of Example 11, wherein the first translatable member has adistal end defining an elongate slot, wherein the first pivotal couplingcomprises a pin disposed in the elongate slot, wherein the elongate slotis configured to accommodate movement of the clamp arm toward and awayfrom the ultrasonic blade between the second position and the thirdposition.

Example 13

The apparatus of claim 2, further comprising a translating member,wherein the translating member is operable to translate between a firstmode position and a second mode position, wherein the translating memberis configured to prevent movement of the clamp arm from the first closedposition to the second closed position when the translating member is inthe first mode position, wherein the translating member is configured topermit movement of the clamp arm from the first closed position to thesecond closed position when the translating member is in the second modeposition.

Example 14

The apparatus of any one or more of Examples 2 through 13, wherein theshaft assembly further comprises a stop, wherein the stop is configuredto move from an inactive position to an active position, wherein thestop is configured to restrict the clamp arm from pivoting to the secondclosed position in the active position.

Example 15

The apparatus of Example 14, wherein the stop is configured to translaterelative to the acoustic waveguide from the inactive position to theactive position.

Example 16

The apparatus of any one or more of Examples 14 through 15, wherein thestop if fixed to the waveguide, wherein the waveguide is configured torotate to move the stop from the inactive position to the activeposition.

Example 17

An apparatus for operating on tissue, the apparatus comprising: (a) abody; (b) a shaft assembly, wherein the shaft assembly extends distallyfrom the body, wherein the shaft assembly defines a longitudinal axis,wherein the shaft assembly comprises: (i) an acoustic waveguide, whereinthe waveguide is configured to acoustically couple with an ultrasonictransducer, (ii) a first translatable member, wherein the firsttranslatable member is configured to translate relative to the body, and(iii) a second translatable member, wherein the second translatablemember is configured to translate relative to the body; and (c) an endeffector, wherein the end effector comprises: (i) an ultrasonic blade inacoustic communication with the waveguide, and (ii) a clamp arm, whereinthe clamp arm is configured to pivot about a first pivot point towardand away from the ultrasonic blade along a first angular path from afirst position to a second position in response to translation of thefirst translatable member relative to the body, wherein the clamp arm isfurther configured to pivot about a second pivot point toward and awayfrom the ultrasonic blade along a second angular path from the secondposition to a third position in response to translation of the secondtranslatable member relative to the body.

Example 18

The apparatus of Example 17, wherein the first translatable membercomprises a first tube, wherein the second translatable member comprisesa second tube, wherein the first and second tubes are coaxially alignedwith each other about the longitudinal axis.

Example 19

A method of operating on tissue using an apparatus, wherein theapparatus comprises a shaft assembly and an end effector, wherein theshaft assembly defines a longitudinal axis, wherein the end effectorcomprises a clamp arm and an ultrasonic blade, the method comprising:(a) positioning the ultrasonic blade near tissue; (b) pivoting the clamparm about a first pivot point toward the ultrasonic blade to therebycompress the tissue between the clamp arm and the ultrasonic blade,wherein the act of pivoting the clamp arm comprises driving the clamparm along a first angular path from a first position to a secondposition; (c) pivoting the clamp arm about a second pivot point towardthe ultrasonic blade to thereby further compress the tissue between theclamp arm and the ultrasonic blade, wherein the act of translating theclamp arm comprises driving the clamp arm along a second angular pathfrom the second position to a third position; and (d) activating theultrasonic blade to vibrate at an ultrasonic frequency, thereby cuttingthe tissue with the ultrasonic blade.

Example 20

The method of Example 19, wherein the apparatus further comprises atrigger and a grip, wherein the act of pivoting the clamp arm about thefirst pivot point toward the ultrasonic blade comprises moving thetrigger through a first range of motion toward the grip, wherein the actof pivoting the clamp arm about the second pivot point toward theultrasonic blade comprises moving the trigger through a second range ofmotion toward the grip.

V. MISCELLANEOUS

It should be understood that any of the versions of instrumentsdescribed herein may include various other features in addition to or inlieu of those described above. By way of example only, any of theinstruments described herein may also include one or more of the variousfeatures disclosed in any of the various references that areincorporated by reference herein. It should also be understood that theteachings herein may be readily applied to any of the instrumentsdescribed in any of the other references cited herein, such that theteachings herein may be readily combined with the teachings of any ofthe references cited herein in numerous ways. Other types of instrumentsinto which the teachings herein may be incorporated will be apparent tothose of ordinary skill in the art.

It should also be understood that any ranges of values referred toherein should be read to include the upper and lower boundaries of suchranges. For instance, a range expressed as ranging “betweenapproximately 1.0 inches and approximately 1.5 inches” should be read toinclude approximately 1.0 inches and approximately 1.5 inches, inaddition to including the values between those upper and lowerboundaries.

It should be appreciated that any patent, publication, or otherdisclosure material, in whole or in part, that is said to beincorporated by reference herein is incorporated herein only to theextent that the incorporated material does not conflict with existingdefinitions, statements, or other disclosure material set forth in thisdisclosure. As such, and to the extent necessary, the disclosure asexplicitly set forth herein supersedes any conflicting materialincorporated herein by reference. Any material, or portion thereof, thatis said to be incorporated by reference herein, but which conflicts withexisting definitions, statements, or other disclosure material set forthherein will only be incorporated to the extent that no conflict arisesbetween that incorporated material and the existing disclosure material.

Versions of the devices described above may have application inconventional medical treatments and procedures conducted by a medicalprofessional, as well as application in robotic-assisted medicaltreatments and procedures. By way of example only, various teachingsherein may be readily incorporated into a robotic surgical system suchas the DAVINCI™ system by Intuitive Surgical, Inc., of Sunnyvale, Calif.Similarly, those of ordinary skill in the art will recognize thatvarious teachings herein may be readily combined with various teachingsof U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool withUltrasound Cauterizing and Cutting Instrument,” published Aug. 31, 2004,the disclosure of which is incorporated by reference herein.

Versions described above may be designed to be disposed of after asingle use, or they can be designed to be used multiple times. Versionsmay, in either or both cases, be reconditioned for reuse after at leastone use. Reconditioning may include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, someversions of the device may be disassembled, and any number of theparticular pieces or parts of the device may be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, some versions of the device may be reassembled forsubsequent use either at a reconditioning facility, or by an operatorimmediately prior to a procedure. Those skilled in the art willappreciate that reconditioning of a device may utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

By way of example only, versions described herein may be sterilizedbefore and/or after a procedure. In one sterilization technique, thedevice is placed in a closed and sealed container, such as a plastic orTYVEK bag. The container and device may then be placed in a field ofradiation that can penetrate the container, such as gamma radiation,x-rays, or high-energy electrons. The radiation may kill bacteria on thedevice and in the container. The sterilized device may then be stored inthe sterile container for later use. A device may also be sterilizedusing any other technique known in the art, including but not limited tobeta or gamma radiation, ethylene oxide, or steam.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometrics, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1-20. (canceled)
 21. An apparatus for operating on tissue, the apparatuscomprising: (a) an end effector, wherein the end effector comprises: (i)an ultrasonic blade, and (ii) a clamp arm pivotable relative to theultrasonic blade between an open position, a first closed positionassociated with a first mode of operation, and a second closed positionassociated with a second mode of operation; and (b) a shaft assembly,wherein the shaft assembly comprises: (i) an acoustic waveguide inacoustic communication with the ultrasonic blade, wherein the acousticwaveguide is configured to acoustically couple with an ultrasonictransducer, (ii) a translating member operatively coupled with the clamparm, wherein the translating member is configured to translate relativeto the acoustic waveguide in order to pivot the clamp arm relative tothe ultrasonic blade, and (iii) a mode selection assembly configured totransition between a first position and a second position, wherein themode selection assembly in the first position is configured to allow thetranslating member to pivot the clamp arm between the open position andthe first closed position, wherein the mode selection assembly in thesecond position is configured to allow the translating member to pivotthe clamp arm between the open position and the second closed position.22. The apparatus of claim 21, wherein the mode selection assemblyfurther comprises a pivot arm pivotably coupled with the clamp arm via apin, wherein the move selection assembly is configured to pivot thepivot arm and the pin between a first vertical position and a secondvertical position when the mode selection assembly transitions betweenthe first position and the second position.
 23. The apparatus of claim22, wherein the shaft assembly comprises a static member, wherein thetranslating member is configured to translate relative to the staticmember.
 24. The apparatus of claim 23, wherein the pivot arm is furtherpivotably coupled with the static member.
 25. The apparatus of claim 24,wherein the mode selection member comprises a translating sledconfigured to drive the pivot arm and the pin between the first verticalposition and the second vertical position.
 26. The apparatus of claim25, wherein the translating sled is interposed between the static memberand the pivot arm.
 27. The apparatus of claim 26, wherein the pivot armcomprises a semi-cylindrical member disposed around at least a portionof the static member.
 28. The apparatus of claim 26, wherein the pivotarm is biased toward the first vertical position.
 29. The apparatus ofclaim 26, further comprising a body, wherein the body comprises atrigger configured to actuate the translating member relative to thewaveguide.
 30. The apparatus of claim 29, wherein the trigger is furtherconfigured to drive the translating sled.
 31. The apparatus of claim 29,wherein the body further comprises a sliding body operatively coupled tothe mode selection assembly, wherein the sliding body is configured todrive the translating sled.
 32. The apparatus of claim 23, wherein theshaft assembly comprises a second translating member, wherein the pivotarm is pivotably coupled to the second translating member.
 33. Theapparatus of claim 32, wherein the pivot arm is pivotably coupled withthe second translating member via a four-bar linkage.
 34. The apparatusof claim 21, wherein the mode selection member comprises a stop, whereinthe stop is configured to allow the clamp arm to rotate to the secondclosed position with the mode selection member in the second position,wherein the stop is configured to inhibit rotation of the clamp arm withthe mode selection member in the first position thereby restricting theclamp arm to the first closed position.
 35. The apparatus of claim 34,wherein the stop comprises a translating member.
 36. The apparatus ofclaim 34, wherein the stop is affixed to the acoustic waveguide, whereinthe waveguide is configured to rotate the stop.
 37. An apparatus foroperating on tissue, the apparatus comprising: (a) a shaft assembly,wherein the shaft assembly comprises: (i) an acoustic waveguideconfigured to acoustically couple with an ultrasonic transducer, and(ii) a translating member configured to translate relative to theacoustic waveguide; and (b) an end effector, wherein the end effectorcomprises: (i) an ultrasonic blade in acoustic communication with theacoustic waveguide, and (ii) a clamp arm assembly comprising: (A) afirst clamp arm pivotable relative to the ultrasonic blade between anopen position and a first closed position associated with a first modeof operation, and (B) a second clamp arm pivotable with the first clamparm relative to the ultrasonic blade between the open position and thefirst closed position, wherein the second clamp arm is configured topivot relative to the first clamp arm in the first closed position to asecond closed position associated with a second mode of operation,wherein the translating member is configured to pivot the first clamparm and the second clamp arm.
 38. The apparatus of claim 27, wherein thetranslating member comprises a flexible distal end configured to flexwhen the second clamp arm pivots to the second closed position.
 39. Theapparatus of claim 38, wherein the first clamp arm comprises a cammingsurface configured to flex the flexible distal end of the translatingmember.
 40. An apparatus for operating on tissue, the apparatuscomprising: (a) an end effector, wherein the end effector comprises: (i)an ultrasonic blade, and (ii) a clamp arm pivotable relative to theultrasonic blade between an open position, a first closed positionassociated with first mode of operation, and a second closed positionassociated with a second mode of operation; (b) a shaft assembly,wherein the shaft assembly comprises: (i) an acoustic waveguide inacoustic communication with the ultrasonic blade, wherein the acousticwaveguide is configured to acoustically couple with an ultrasonictransducer; (ii) a translating member configured to drive the clamp armbetween the open position, the first closed position, and the secondclosed position; and (c) a mode selection assembly configured to actuatebetween a first position and a second position, wherein the modeselection assembly in the first position is configured to restrict theclamp arm from pivoting toward the first closed position, and whereinthe mode selection assembly in the second position is configured torestrict the clamp arm from pivoting toward the second closed position.